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Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures; a prospective randomized comparison

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Aim

We sought to determine whether intramedullary fixation with proximal femoral nail antirotation produces comparable outcomes to dynamic hip screw in the treatment of unstable trochanteric fractures.

Materials and methods

Patients were randomly allocated to receive proximal femoral nail antirotation (Group 1, n = 96, mean age; 77.22 ± 6.82 years) or dynamic hip screw (Group 2, n = 102, mean age; 76.86 ± 6.74 years). Outcome measures were time of operation and fluoroscopy, amount of blood loss and occurrence of surgery-related complications. Tip–apex distance and femoral neck shortening were also evaluated. Patients were evaluated at the sixth month to assess the recovery of walking ability. Survival information was obtained from a civil registry.

Results

Operative and fluoroscopy times were significantly shorter and blood loss was significantly lower in Group 1 than those in Group 2. Complication rates, mean tip–apex indices and recovery of walking ability were similar between groups, whereas independent walking was more common in Group 1 than in Group 2. Until the sixth month, screw cutout occurred in eight (7.8 %) and seven (7.3 %) patients in Group 1 and Group 2, respectively (p = 0.88). Three-year survival rate was 61.6 ± 9.4 vs 57.3 ± 9.7 % in Group 1 and Group 2, respectively (p = 0.50).

Conclusion

Proximal femoral nail antirotation technique offers better recovery than dynamic hip screw, whereas both techniques possess the same risk of postoperative complications.

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Conflict of interest

Sinan Zehir, Regayip Zehir, Sultan Zehir, Ibrahim Azboy and Nahide Haykir declare that they have no conflict of interest.

Ethical standard

The study was approved by the local ethics committee. Signed informed consent forms allowing use of medical records for research purposes were obtained from all patients.

Author information

Authors and Affiliations

  1. Hitit University Research and Training Hospital Orthopedic and Traumatology Clinic, 19100 Merkez, Corum, Turkey

    Sinan Zehir

  2. Carsamba State Hospital, Samsun, Turkey

    R. Zehir

  3. Corum Public Health Center, Corum, Turkey

    Sultan Zehir

  4. Dicle Universty Research and Training Hospital Orthopedic and Traumatology Clinic, Diyarbakir, Turkey

    İ. Azboy

  5. Kartal Research and Training Hospital, Istanbul, Turkey

    N. Haykir

Authors
  1. Sinan Zehir
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  2. R. Zehir
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  3. Sultan Zehir
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  4. İ. Azboy
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  5. N. Haykir
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Corresponding author

Correspondence to Sinan Zehir.

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Zehir, S., Zehir, R., Zehir, S. et al. Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures; a prospective randomized comparison. Eur J Trauma Emerg Surg 41, 393–400 (2015). https://doi.org/10.1007/s00068-014-0463-y

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  • DOI: https://doi.org/10.1007/s00068-014-0463-y

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