Treatment of aged intertrochanteric fractures with proximal femoral nail antirotation: a comparison of close reduction and open reduction

Objective To compare the curative effect of proximal femoral nail antirotation( PFNA) by close reduction with that of PFNA by open reduction on aged intertrochanteric fractures. Methods Eighty-seven elderly patients with intertrochanteric fractures treated with PFNA( open reduction in 32 cases and close reduction in 55) were analyzed retrospectively. The wound size,operation time,blood loss,satisfactory reduction,adequate screw position, part weight-bearing time,fracture healing time,complications,and functional outcomes were compared between 2 groups. Results The wound size,operation time and blood loss in the close group were significantly less than those in the open group( P 0. 01). When compared with the open reduction group,the rate of satisfactory reduction was significantly higher( P 0. 05) in the close reduction group. All 87 patients were followed up,and the follow-up time was 12 ~ 42 months in the close reduction group and 12 ~ 48 months in the open reduction group. The part weightbearing time in the close reduction group was significantly earlier than that in the open reduction group( P 0. 01). The complication rate was 22% in the open reduction group and there were not any serious complications in the close reduction group,showing significant difference( P 0. 01). All fractures were healed and no significant difference was found in fracture healing time between two groups( P 0. 05). At last follow-up,the Harris hip score was higher in the close reduction group than that in the open reduction group,showing significant difference( P 0. 01). Conclusions When compared with open reduction,close reduction by orthopedic traction table with PFNA is an better method for treatment of aged intertrochanteric fractures because of simple operation and better functional recovery.