Proximal femoral nail antirotation versus external fixation for unstable intertrochanteric fractures in elderly patients: A randomized controlled trial

Background: This study aimed to compare the clinical and radiographic outcomes of the proximal femoral nail antirotation (PFNA) and external fixation in the management of unstable intertrochanteric fractures in elderly patients. Methods: Eighty-seven of 114 patients with unstable intertrochanteric fractures were included in this study between January 2015 and June 2019, 46 were fixed with PFNA implant and 41 with external fixator. Patient baseline characteristics, functional and radiographic results, and postoperative complication were documented and compared between the 2 groups. Results: Prolonged operation duration, increased fluoroscopy time, and excess blood loss occurred in PFNA group. The functional results scores seemed higher in the PFNA than external fixation group in the first semester, and thereafter, there was no significant difference between groups. On early postoperative radiographs, better femur neck-shaft angle was acquired in the external fixators device, but the difference did not continue at final visit. The incidence rate of overall complications was 43.5% for the group PFNA and 100% for the group external fixation. Conclusions: Fewer postoperative complications occurred in PFNA than external fixator group when unstable intertrochanteric fractures were treated. Nevertheless, there was no significant difference detected in final functional and radiographic outcome between the 2 groups.