Comparison of the efficacy of proximal femoral nail antirotation (PFNA) and dynamic hip screw (DHS) in the treatment of seinsheimer v-type of subtrochanteric fracture with sarcopenia.

From January 2016 to December 2018, 52 patients with seinsheimer V-type subtrochanteric fracture complicated with sarcopenia were retrospectively analyzed. Sarcopenia was diagnosed by grip strength and skeletal muscle index (SMI). They were divided into PFNA group (28 cases) and DHS group (24 cases). The age, gender, injury to operation time, SMI value, incision length, operation time, intraoperative blood loss, fluoroscopy times, perioperative blood transfusion, lower limb full weight-bearing time, visual analogue scale (VAS) and Harris score at 3 months and the last follow-up were compared between the two groups, as well as the complications.

All patients were followed up. There was no significant difference in age, gender, injury to operation time and SMI between the two groups (t=0.054, P=0.957, χ²=0.018, P=0.894, t=0.044, P=0.965, t=-1.298, P=0.200). The incision length, blood loss and blood transfusion in PFNA group were less than those in DHS group, and the number of fluoroscopy in operation was more than that in DHS group (t=-13.016, P=0.000, t=-5.305, P=0.000, t=-2.505, P=0.016, t=9.293, P=0.000). There was no significant difference in operation time between the two groups (t=0.432, P=0.668). In PFNA group, the time of complete weight-bearing was earlier, the VAS score was lower 3 months after operation, but the Harris score was higher, the difference was statistically significant (t=-3.874, P=0.000; z=-2.009, P=0.045; t=7.139, P=0.000), but there was no significant difference in VAS score and Harris score between the two groups at the last follow-up (z=-1.166, P=0.243; t=0.733, P=0.468). In PFNA group, 1 case had internal fixation loosening, and the incidence of complications was 3.57%. In DHS group, 2 cases had wound infection, and 5 cases had internal fixation loosening, and the incidence of complications was 29.17%. The difference was statistically significant (χ²=4.686, P=0.030).

PFNA and DHS are both effective methods in the treatment of seinsheimer V type subtrochanteric fracture with sarcopenia, but PFNA has shorter incision, less blood loss, faster recovery and lower incidence of complications, which can be preferred.