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

Zehir S., Zehir R., Zehir S., Azboy İ., Haykir N.

European Journal of Trauma and Emergency Surgery, vol.41, no.4, pp.393-400, 2015 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 41 Issue: 4
  • Publication Date: 2015
  • Doi Number: 10.1007/s00068-014-0463-y
  • Journal Name: European Journal of Trauma and Emergency Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.393-400
  • Keywords: Hip fracture, Hip screw, Osteoporosis, Proximal femoral nail
  • Istanbul Medipol University Affiliated: No


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.