Comparison of Outcomes Between Two-Screw Proximal Femoral Nail and Halifax Femoral Nail in Elderly Patients With Intertrochanteric Fractures

TL;DR

This study compares two surgical implants for hip fractures in elderly patients and finds the Halifax nail to be more effective and safer than the two-screw proximal femoral nail.

Contribution

The study provides a direct comparison of clinical outcomes between two intramedullary devices for treating unstable trochanteric fractures in the elderly.

Findings

The Halifax nail had shorter operative time and fewer complications compared to the PFN.

Patients with the Halifax nail achieved full weight-bearing earlier than those with the PFN.

The Halifax nail had a lower tip-apex distance, indicating better implant positioning.

Abstract

Introduction: Trochanteric fractures represent a substantial proportion of hip fractures in the elderly and are associated with significant morbidity and mortality. Dynamic hip screw fixation has shown higher failure rates in unstable fractures, leading to the use of intramedullary implants such as the proximal femoral nail (PFN) and the Halifax (Gamma) nail.

Methods: A cross-sectional study was conducted on 134 patients aged 60-80 years with unstable trochanteric fractures admitted to the Trauma Center of the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, from 2019 to 2021. Patients were randomly divided into two equal groups (n = 67 each), receiving either PFN (Nebula Surgical, Rajkot, India) or Halifax nail (GESCO Healthcare, Chennai, India) fixation. Clinical and radiological outcomes were assessed at one, three, six, and 12 months, and complications were recorded.

Results: The mean age of patients was 69.3 years, with a female predominance. The mean operative duration was significantly shorter in the Halifax group (45.9 minutes) compared to the PFN group. Patients with the Halifax nail achieved full weight-bearing earlier (eight weeks) and had fewer complications, such as the Z-effect, screw back-out, and femoral shaft fractures, which were observed more frequently in the PFN group. Union rates were similar in both groups (93.4%). The mean tip-apex distance (TAD) was lower in the Halifax group (14.4 ± 3.2 mm) compared to the PFN group (20.9 ± 2.7 mm).

Conclusion: The Halifax femoral nail demonstrated several advantages over the PFN, including shorter operative time, earlier mobilization, and fewer complications, making it a promising option for managing unstable trochanteric fractures in elderly patients.

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