DHS vs. PFNA vs. Gamma Nail for the T f P i l F lTreatment of Proximal Femoral

Fractures. Early Complications, and y p ,Functionality Outcomes.

A. Abbas, A. Lerner, H. Shehade, D. Rothem, B. Khatib. Department of Orthopedic Surgery

Ziv Medical Center, Zefat.

INTRODUCTIONINTRODUCTION

Intertrochanteric fractures:

►Occur between greater and lesser trochanter.

►Account for 50% of all proximal femoralproximal femoral fractures.

►More prevalent in elderly►More prevalent in elderly women.

► Subtrochanteric Fractures:

► Between the greater gand lesser trochanter and a point 5 cmand a point 5 cm below the lesser trochanter.

► A t f 10 30%► Account for 10-30% of all hip fractures. p

Stability of the fracture and fixation depends on:

►Bone quality►Fracture pattern►Fracture reduction►Fracture reduction►Type of implant?yp p

Intramedullar or t a edulla oextramedullar device?

What device provides What device provides better fracture stability to thestability to the fracture to allows

l bili ?early mobility? What’s The effect later of on patient’s functionality? f y

Used DevicesUsed Devices

1. Intramedullary nails used included Gamma Nail 3 and PFN-A.

2. Extramedullary devices were used is DHS.2. Extramedullary devices were used is DHS.

PurposePurpose

►The aim of our study

was to compare early

results and

complication rate, and

l dilate outcomes regarding

patient’s functionalitypatient s functionality.

P i d F h l► Prospective data was analyzed

i l

► For the late functionality evaluation

k d h iretrospectively to assess the early results

d li i

we asked the patients to answer a questionnaire

i hand complications. via phone.

Parameters analyzedParameters analyzed

► Analysed early data:

► Mean operative time► Blood transfusion► Blood transfusion► Mobility and Full weight bearing► Postoperative infection► Postoperative infection► Operative incision

Functionality Questionnairey

► Abilit to dress independentl► Ability to dress independently.

► Transferring.

► Walking across.

► Climbing stairs.

► Walking 500 meters.g

Materials and MethodsMaterials and Methods

►157 patients were operated on between 04.2010 - 04.2012.

►All the patients►All the patients included in this study lived independentlylived independently.

►Patients who were di bl d d thdisabled and those with pathological fractures were excluded.

►DHS was used for stable Intertrochanteric fractures.

►PFN-A or Gamma nail 3 were used for unstable Intertochanteric fractures and Subtrochanteric fracturesSubtrochanteric fractures.

►35 were treated with a DHS and 72i A 0 i G i 3with a PFNA, 50 with Gamma Nail 3.

Demographic tablePercentageTotal number of patients

n=157Characteristic

SexSex

40%63Male

60%94Female

Side

57%89Left

40%68Right

Age

4%620-39

9%1440-59

50%7960-79

37%5880-99

Device

22%35DHS 22%35DHS

46%72PFNA

32%50Gamma Nail-3

Early resultsEarly results

►Mean operation time:DHS: 53 minutes

PFNA: 37 minutesG 35 i tGamma: 35 minutes

►Blood transfusion:DHS: 2.2 unitsPFNA: 2 0 unitsPFNA: 2.0 unitsGamma: 1.8 units

►Mobilization (EFWB):►Mobilization (EFWB):22/35 (63%) patients in DHS group. 69/72 (96%) patients of the PFNA.49/50 (98%) patients in Gamma nail group49/50 (98%) patients in Gamma nail group.

►Incision length:DHS: 10-15 cm,,PFNA and Gamma Nail: 5-6 cm proximal

and 1-2 cm distal incisionand 1-2 cm distal incision.

►There was no postoperative infections in all►There was no postoperative infections in all cases.

►2 Revision surgeries were performed in PFNA group.

Late resultsLate results

► In the DHS group 9/35 (25%) patients died in the postop period. Survivors had mean functionality score of 4.0 pre op and 2.6 postop.

► In the PFNA group 21/72 (29%) patients died in the g p ( ) ppostop period. Survivors had a mean functionality score of 3.8 prop and 2.2 postop.

► In the Gamma nail group 10/50 (20%) patients died in the postop period. Survivors had functionality score ofthe postop period. Survivors had functionality score of 3.8 pre op and 2.3 postop.

C l iConclusion:

Operation time was shorter and operative blood loss was less in intramedullary fixation.

O ti i i i i l i i i t d llOperative incision is less invasive intramedullary group.

Mechanical stability achieved by intramedullary fixation is higher compared with DHS, although most of patients received intramedullary fixation had comminuted an unstable fracturesintramedullary fixation had comminuted an unstable fractures.

►Functionality declined postoperatively in all ipatient groups.

►We had noticed no functionality difference►We had noticed no functionality difference in patients who received intramedullary fixation i e PFNA vs Gamma nailfixation, i.e. PFNA vs. Gamma nail.

►Patients who had DHS fixation had slightly better functionality results and we think due to the fracture pattern (stable fracture).p ( )