title: Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures; a prospective randomized comparison.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Proximal femoral nail antirotation technique offers better recovery than dynamic hip screw, whereas both techniques possess the same risk of postoperative complications.
authors.affiliation: Hitit University Research and Training Hospital Orthopedic and Traumatology Clinic, 19100 Merkez, Corum, Turkey, sinanzehir@yahoo.com.
authors.forename: Sinan
authors.initials: S
authors.lastname: Zehir
authors.forename: R
authors.initials: R
authors.lastname: Zehir
authors.forename: Sultan
authors.initials: S
authors.lastname: Zehir
authors.forename: İ
authors.initials: İ
authors.lastname: Azboy
authors.forename: N
authors.initials: N
authors.lastname: Haykir
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D017102:Fracture Healing / Q000502:physiology; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D012399:Rotation; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers; D016896:Treatment Outcome