Association Between PFNA Trochanteric Protrusion Height and Hip Pain in Geriatric Patients with Pertrochanteric Fractures
Abstract
Introduction: Per-/intertrochanteric femur fractures in the elderly are commonly treated surgically, with the Proximal Femoral Nail Antirotation (PFNA) system being a frequent implant choice. However, concerns exist about its compatibility with the proximal femur geometry in Asian patients, potentially leading to post-operative hip pain. This study aimed to assess the association between PFNA trochanteric protrusion height and post-operative hip pain, functional outcomes, and the development of trochanteric bursitis in geriatric patients.
Materials and methods: Patients aged 60 and older with per-/intertrochanteric fractures treated with the PFNA system were recruited. Subjects were categorised by trochanteric protrusion height (<1cm, 1-1.5cm, >1.5cm). The association between protrusion height and post-operative hip pain (measured by the Numeric Rating Scale), functional outcomes (assessed by the modified Harris Hip Score : mHHS ), and trochanteric bursitis was evaluated at one- and three-months post-surgery.
Results: Among 101 patients, 92% had trochanteric protrusion with a median height of 0.96cm, and 53.47% experienced lateral hip pain. Protrusion heights >1.5cm were associated with significantly higher pain scores at one and three months (p = 0.008 and p = 0.001, respectively) and a higher likelihood of developing trochanteric bursitis (OR = 9.49, p = 0.001). Protrusion heights >1 cm was associated with poorer functional outcomes (mHHS) at one and three months.
Conclusion: Greater PFNA trochanteric protrusion height is associated with increased hip pain, a higher risk of trochanteric bursitis, and poorer functional outcomes. These findings emphasise the need for thorough pre-operative planning and review of proper surgical techniques to optimise outcomes and reduce complications.
Abstract | Reference
