EFFECT OF INTRAOPERATIVE DISTAL LOCKING WITHPROXIMAL FEMORAL NAIL ANTIROTATION ON THE CLINICAL OUTCOME OF PATIENTS WITH FEMORAL INTERTROCHANTERIC FRACTURE WITH INTACT EXTERNAL WALL

Yuxin Shen, Pan Guo^*

Department of Orthopedics, The First People’s Hospital of Huzhou, First Affiliated Hospital of Huzhou Teachers College, Huzhou, Zhejiang, 313000, PR China

Objective: To investigate the effect of distal locking with proximal femoral nail antirotation (PFNA) on the clinical outcome of patients with femoral intertrochanteric fracture with intact external wall. 

Methods: A total of 122 patients who received PFNA treatment for femoral intertrochanteric fracture with intact external wall in our hospital from January 2019 to January 2022 were included retrospectively. Whether the distal end would be locked or not was determined according to the doctor’s choice and the patient's wish. There were 38 cases who didn’t undergo distal locking (non-locking group), 43 cases who underwent distal locking with dynamic screw (dynamic screw group) and 41 cases who underwent distal locking with static screw (static screw group). Perioperative clinical indicators, fracture healing time, postoperative Harris hip score and incidence of postoperative complications were compared among three groups. 

Results: The surgery time and intraoperative blood loss of the non-locking group were significantly lower than those of the other two groups (P<0.05). The incision length of the non-locking group was significantly shorter than that of the other two groups (P<0.05). There were no significant differences among the three groups in length of stay, fracture healing time and postoperative Harris hip score (P>0.05). There was no significant difference among three groups in total incidence of postoperative complications (P>0.05). 

Conclusion: Whether distal locking is performed during PFNA surgery or not, the influences on the fracture healing and safety of patients with femoral intertrochanteric fracture with intact external wall are close. Meanwhile, the absence of distal locking is conducive to shorten surgery time and lower the degree of iatrogenic trauma.