Comparison of Thigh Pain in Short Versus Long Proximal Femoral Nails in Patients With Intertrochanteric Femur Fracture: A Comparative Study

TL;DR

This study compares thigh pain and outcomes in patients with hip fractures treated with long or short femoral nails, finding that long nails reduce pain and complications in Indian patients.

Contribution

The study provides new evidence on the benefits of long proximal femoral nails in reducing anterior thigh pain and complications in intertrochanteric fractures.

Findings

Long PFN had significantly lower anterior thigh pain (2%) compared to short PFN (18%).

Complications like femoral canal impingement and varus collapse occurred only in the short PFN group.

Functional outcomes (Harris Hip Score) were similar between the two groups.

Abstract

Introduction

Hip fractures, particularly intertrochanteric femur fractures, pose a significant public health challenge, with the global incidence projected to rise. In India, the annual incidence of osteoporotic hip fractures is expected to increase due to the growing geriatric population. The choice of fixation for these fractures remains contentious, with proximal femoral nail (PFN) emerging as a preferred option due to its biomechanical advantages. This study evaluates the outcomes of long and short PFN in managing intertrochanteric fractures, focusing on anterior thigh pain and functional outcomes.

Method

A retrospective study was conducted on 100 patients treated with long PFN (n=50) or short PFN (n=50) at MAX Super Specialty Hospital, New Delhi, from January 2020 to December 2021. Data from medical records and radiographs were analyzed for fracture union, anterior thigh pain (Visual Analog Scale (VAS) score, Verbal Rating Scale), and functional outcomes (Harris Hip Score). Complications were also assessed. Statistical analyses were performed using SPSS v23 (IBM Corp, Armonk, NY), with significance at p<0.05.

Result

The incidence of anterior thigh pain was significantly higher in the short PFN group (18%) compared to the long PFN group (2%) (p=0.017). The mean VAS score was 2.26 ± 1.42 for the short PFN group versus 1.68 ± 0.91 for the long PFN group. While the Harris Hip Scores were comparable (short PFN: 76.18 ± 11.74, long PFN: 78 ± 11.52, p=0.436), complications such as femoral canal impingement (n=4) and varus collapse (n=3) were observed exclusively in the short PFN group.

Conclusion

Long PFN demonstrated advantages in reducing anterior thigh pain and minimizing complications, particularly in populations with shorter stature and bowed femurs, common in the Indian subcontinent. Although functional outcomes were similar for both groups, long PFN appears to be the preferred choice for intertrochanteric fractures in this demographic. Further studies with longer follow-up durations are recommended to validate these findings.