Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2022; 13(3): 267-277
Published online Mar 18, 2022. doi: 10.5312/wjo.v13.i3.267
Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws
Nadeem A Lil, Vipul R Makwana, Tirth D Patel, Arjav R Patel
Nadeem A Lil, Vipul R Makwana, Tirth D Patel, Arjav R Patel, Department of Orthopaedics, NHL Medical College, Ahmedabad 380006, Gujarat, India
Author contributions: Lil NA, Makwana VR, Patel TD and Patel AR made substantial contributions to the study conception and design, to the acquisition, analysis and interpretation of data, and to the drafting of the article and making critical revisions related to important intellectual content of the manuscript; and all authors provided final approval of the version of the article to be published.
Institutional review board statement: This study was reviewed and approved by the NHL institutional review board (NHLIRB).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they do not have any conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nadeem A Lil, MS, Professor, Department of Orthopaedics, NHL Medical College, Ellis Bridge, Ahmedabad 380006, Gujarat, India. nadeemlil@yahoo.com
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: July 28, 2021
Revised: August 7, 2021
Accepted: February 9, 2022
Article in press: February 9, 2022
Published online: March 18, 2022
Abstract
BACKGROUND

Intertrochanteric (IT) fracture is one of the most common fractures seen in an orthopaedic practice. Proximal femoral nailing (PFN) is a common modality of fixing IT femur fracture. We retrospectively studied whether a PFN with two proximal lag screws can be done without distal interlocking screws in the 31-A1 and 31-A2 fracture patterns according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) guidelines for IT femur fractures.

AIM

To compare the outcomes of IT fractures (AO/OTA 31-A1 and 31-A2) treated by PFN with and without distal interlocking screws.

METHODS

We carried out a retrospective study of 140 patients in a tertiary care centre who had AO/OTA type 31-A1 and 31-A2 IT fractures. We divided the patients into two groups, in which one of the groups received distal interlocking screws (group 1) and the other group did not (group 2). The subjects were followed up for a mean period of 14 mo and assessed for radiological union time, fracture site collapse, mechanical stability of implant, and complications associated with the PFN with distal interlocking and without distal interlocking. Then, the results were compared.

RESULTS

PFN without distal interlocking screws has several advantages and gives better results over PFN with distal interlocking screws in the AO/OTA 31-A2 fracture pattern. However, similar results were observed in both groups with the fracture pattern AO/OTA 31-A1. In patients with fracture pattern AO/OTA 31-A2 treated by PFN without distal interlocking screws, there were minimal proximal lock-related complications and no risk of distal interlock-related complications. The operative time, IITV radiation time and time to radiological union were reduced. These patients also had better rotational alignment of the proximal femur, and the anatomy of the proximal femur was well maintained. It was also noted that in the cases where distal interlocking was performed, there was a gradual decrease in neck shaft angle, which led to varus collapse and failure of bone-implant construct in 21.40%.

CONCLUSION

In fracture pattern AO/OTA 31-A2, PFN without distal interlocking had better results and less complications than PFN with distal interlocking.

Keywords: Intertrochanteric fracture, Arbeitsgemeinschaft für Osteosynthesefra-gen/Orthopaedic Trauma Association 31-A1 and 31-A2, Proximal femoral nail, Distal interlocking screws, Without distal interlocking screws, Outcome

Core Tip: There are few studies comparing clinical and radiological results of proximal femoral nail (PFN) with and without distal interlocking in fracture pattern 31-A1 and 31-A2 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association guidelines. From this retrospective study, we conclude that in type 31-A1 intertrochanteric fractures use of long anatomical PFN with or without distal interlocking screws have similar results in terms of radiological union, postoperative proximal femur anatomy, and rotational alignment. In type 31-A2, the use of long anatomical PFN without distal interlocking screws gives better results and less proximal lock-related complications than PFN with distal interlocking screws.