Comparison of Surgical, Functional and Radiological Outcomes following Integrated Screw and Nail System (ISNS)Versus Helical-Blade Anti- rotation Proximal Femoral Nail (PFNA2) in Trochantreic fractures - a Randomised Control Trial.

Hip fractures are one of the most prevalent orthopaedic injuries as more than a million human subjects are prone for the same. Nearly half of all hip fractures are intertrochanteric femur fractures (IFFs), which are more common among the elderly and are often as a result of low-energy traumas. In order to achieve a satisfactory early recovery of the injured patients, surgical treatment is mandatory to manage these fractures. The gold standard therapy for stable intertrochanteric fractures, was earlier the dynamic hip screw (DHS) implant. However, they were found inadequate for the stabilizing fractures of the unstable kind. Contrarily, as opposed to extramedullary devices such as DHS, proximal femoral nails (PFN) have a biomechanical advantage because of their closer location to the vector of force as opposed to extramedullary devices, and shorter moment arm. Moreover, based on the results of several earlier reports, intramedullary fixation may be preferable to extramedullary fixation for hip fracture patients as the functional scores are higher and there is a lower risk of implant failure and reoperation. Further, only a minimally invasive procedure is required to implant a PFN. Therefore, a closed reduction of the fracture, aids to maintain the haematoma, and the surgeon can perform a minimally invasive procedure with least possible soft-tissue dissection, thereby lowering surgical trauma, blood loss, infection, and wound complications.

Healing of the bones is significantly managed by the interfragmentary linear compression provided by the lag screw in majority of the PFNs. One or two lag screws, integrated or locked lag screws, and a wedge block that offers rotational stability are some of the PFN designs available in the market. Clinical and radiological evaluations of only two distinct PFNs have been studied extensively. However, only few studies have compared the differences between ISNS and PFNA2 with respect to its surgical outcome, and radiological outcome in patients treated with closed reduction and internal fixation for IFFs and this study aims to bring in more light in this area.