Clinical effects and helical blade positions in the treatment of senile intertrochanteric fractures with proximal femoral nail antirotation

Abstract

Objective To compare the clinical effects of 2 common installation positions of the helical blade in the treatment of senile intertrochanteric fractures with proximal femoral nail antirotation (PFNA).Methods From January 2010 to December 2012,166 old patients with intertrochanteric fracture were treated by PFNA.According to the installation position of the helical blade in the femoral head on the postoperative X-ray films,they were divided into a C/C group (87 cases) where the helical blade was at the center of the femoral head in both anteroposterior and lateral views and an I/C group (79 cases) where the helical blade was at the inferior one-third of the femoral head in anteroposterior view and at the center in lateral view.There were no significant differences between the 2 groups in general data preoperation (P ＞ 0.05).The 2 groups were compared in terms of reduction quality,tip-apex distance (TAD),full weight bearing time,fracture healing time,and Harris Hip Score(HHS) at the last follow-up.Results C/C group had 83 patients followed for an average of 13.6 months and I/C group had 76 patients followed for an average of 13.3 months.There were no significant differences between the 2 groups regarding the good-to-excellent reduction rate [94.0％ (78/83) versus 94.7％ (72/76)],full weight bearing time (9.4 ± 1.5 weeks versus 9.3 ± 1.3 weeks),fracture healing time (17.8 ±2.3 weeks versus 17.2 ±2.3 weeks),or HHS (89.6 ±4.6 points versus 89.3 ±4.7 points) (P ＞ 0.05).There was a significant difference in TAD (21.14 ± 3.17 mm versus 24.96 ± 3.48 mm) between the 2 groups(t =-7.242,P =0.000).No infection or cut-out or other related complications of the helical blade occurred in either group.Conclusion The helical blade may lead to satisfactory clinical effects in the treatment of senile intertrochanteric fractures with PFNA no matter at which of the 2 positions it is installed. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Helical blade