Comparison of osteoporotic intertrochanteric fracture fixation using a proximal femoral nail with a helical blade and lag screw type proximal femoral nail

Abstract

The aim of the study was to compare clinical and radiological results between the helical blade lag screw (proximal femoral nail antirotation II [PFNA II]) and the traditional lag screw (Zimmer Natural Nail [ZNN]) in the operative treatment of osteoporotic femur intertrochanteric fractures. We selected 182 patients who could be observed for at least 1 year from among 352 patients who received surgical treatment for osteoporotic isolated femur intertrochanteric fractures between January 2013 and December 2016. The PFNA II was applied in 110 cases, and the ZNN in 72 cases. We evaluated operation time, bleeding amount, quality of reduction, tip apex distance, bone union time, sliding distance, and lag screw position. The mean operation times and bleeding volumes were respectively 38 minutes and 224 mL for PFNA II, and 42 minutes and 234 mL for ZNN. The quality of reduction was good, acceptable, and poor in 71%, 25%, and 4% for PFNA II, and 68%, 31%, and 1% for ZNN, respectively. The mean tip apex distances, bone union times, and sliding distances were respectively 21.1 and 20.7 mm, 12.4 and 12.9 weeks, and 4.2 and 3.9 mm. The lag screw position was acceptable and poor in 95% and 5% for PFNA II, and 97% and 3% for ZNN, respectively. The design of the lag screw did not influence the surgical outcome in the osteoporotic isolated femur intertrochanteric fractures. Therefore, choice of the proximal femoral nail can safely be made according to surgeon preference.