Proximal Femoral Nail versus Proximal Femoral Plate Fixation for Unstable Trochanteric Fractures in Elderly Patients

Abstract

Background: Unstable trochanteric fractures in elderly patients present significant challenges, necessitating robust fixation methods to  ensure optimal clinical outcomes. Comparing Proximal Femoral Nail (PFN) and Proximal Femoral Plate (PFP) fixation is crucial for determining the most effective treatment.

Objective: To evaluate the clinical and radiological outcomes of PFN versus PFP fixation for unstable trochanteric fractures in elderly patients.

Patients and Methods: A prospective study was conducted on 20 elderly patients with unstable, closed trochanteric fractures at the  Orthopedic Surgery Department, Faculty of Medicine, Benha University. Patients were divided into two groups: Group I (n=10) underwent  PFN fixation, and Group II (n=10) underwent PFP fixation. Assessments included patient history, clinical examination,  radiological evaluations, and follow-ups at 4 weeks, 12 weeks, 6 months, and 12 months.

Results: No significant differences were found in  baseline characteristics. Group I had significantly lower blood loss (53.4 ± 10.6 ml vs. 137.4 ± 14.6 ml; p=0.02) and shorter hospital stays  (8.2 ± 1.72 days vs. 10.33 ± 2.11 days; p=0.002). Complications were higher in Group II, including pressure sores (0% vs. 40%) and  dislocated prosthesis (10% vs. 50%). Group I showed earlier full weight bearing (4.52 ± 1.22 weeks vs. 8.48 ± 1.64 weeks; p<0.001) and  higher Harris hip scores at 12 months (89.1 ± 1.12 vs. 81.5 ± 2.32; p<0.001).

Conclusions: PFN fixation for unstable trochanteric fractures  in elderly patients is associated with less blood loss, shorter hospital stays, fewer complications, and better functional recovery compared  to PFP fixation, supporting its preferential use