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Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotation and gamma nail 3.

The goal of this study was to compare the results of proximal femoral nail antirotation (PFNA; Synthes, Oberdorf, Switzerland) fixation with those of Gamma nail 3 (GN-3; Stryker, Mahwah, New Jersey) fixation for unstable proximal femoral fractures. A total of 136 unstable trochanteric fractures were divided into 2 treatment groups: 66 patients were treated with the PFNA and 70 were treated with the GN-3. The 2 groups were comparable with regard to demographic variables. Patients treated with the PFNA experienced less intraoperative blood loss (P=.007). Three femoral shaft fractures (2 PFNA, 1 GN-3) were observed intraoperatively; all were minor splits in the cortex at the tip of the nail and were treated successfully with delayed full weight bearing. Follow-up occurred at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Reduction of the fracture was considered good in 74 patients (35 PFNA, 39 GN-3) and the position of the implant was considered ideal in 103 (48 PFNA, 55 GN-3) on postoperative radiographs. The 2 groups were similar with regard to postoperative complications, and no case of cutout or nonunion was noted during the follow-up period. At last follow-up, there was no difference in the functional outcome. Shortening of the femoral shaft was 5.30+/-0.36 mm in PFNA group and 5.49+/-0.39 mm in GN-3 group (P=.73). There was no difference in clinical outcome between the PFNA and GN-3 groups, although the PFNA shows some advantages over the GN-3. We consider these 2 methods to be useful in the treatment of unstable proximal femoral fractures.