Management of Peritrochanteric Femoral Fractures Using Short Versus Long Proximal Femoral Nail A Comparative Study

Abstract

Abstract Purpose The main objective of this study is to compare between using short and long proximal femoral nail (PFN) for management of Peritrochanteric femoral fractures aiming to settle better recommendations for implant selection. Method This is a prospective case series study including 40 patients with traumatic peritrochanteric fractures that was held in Ain Shams University hospitals in the period from 9/2022 till 9/2024, these patients were divided randomly into two groups (A & B) each of 20 patients. Group (A) will be managed with short PFN and group (B) will be managed with long PFN. Intra operative assessment of time of surgery, estimated blood loss, whether the fracture needed an open reduction or not. A follow up period for at least one year where a radiological assessment for time of union and implant related complications (implant failure, cut through, periprotheic fracture) were analyzed; All patients were assessed just post-operative and at 6 weeks, 3, 6, 9, 12 months intervals. A functional assessment at the end of the follow up period was done by Harris Hip score (HHS) and Oxford score (OS). Any related complications (infection, DVT) were recorded. Results In our study, the mean estimated blood loss equal 131.2±89.9 ml for the short PFN was, where it was 286.8±189.9 ml in the long PFN with P value (0.002) which is statistically highly significant. Regarding the operation time; the mean operative time was 63.5±14.6 minutes for the short PFN, while in the long PFN was 97±13.3 minutes with P value (0.0001) which is statistically highly significant. For the mean time for union, the short PFN was 12.05±2.25 weeks while the long PFN was 13.05±2.24 weeks with P value (0.17) which is not statistically significant. Concerning the functional outcome; the mean HHS for short PFN was 81.5±10.96 while for long PFN was 81.9±7.88 with P value (0.88) which is not statistically significant; also in OS there was no statistically significant difference between the two groups (P value = 0.24). As regards complications, no statistical significant was found between the two groups. Conclusion Both short and long PFN are good options for management of Peritrochanteric fractures; except that long PFN has longer mean operative time and blood loss.