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. 2025 Mar 28:16:21514593251327910.
doi: 10.1177/21514593251327910. eCollection 2025.

Advantages of Distal Unlocked Proximal Femoral Nails in the Treatment of Stable Intertrochanteric Fractures in Geriatric Patients: A Single-Center Comparative Randomized Study

Sönmez Sağlam  1 , Omer Ersen  2 , Harun Yasin Tüzün  2 , Cemil Yıldız  2
Affiliations

Advantages of Distal Unlocked Proximal Femoral Nails in the Treatment of Stable Intertrochanteric Fractures in Geriatric Patients: A Single-Center Comparative Randomized Study

Sönmez Sağlam et al. Geriatr Orthop Surg Rehabil. .

Abstract

Background: This study aimed to investigate the effect of omitting a distal locking screw in intramedullary nailing of stable intertrochanteric femur fractures on clinical outcomes.

Methods: Ninety-six patients over 65 years old with stable pertrochanteric fractures (AO/OTA 31-A1 and A2) treated with short/intermediate proximal femoral nails (PFNA-II) were randomly assigned into two groups: Group 1 (distal locked) and Group 2 (distal unlocked). Comparative analyses were conducted on operative time, total fluoroscopy time, blood loss, incision length, complications, and functional outcomes.

Results: The mean operative time was significantly shorter in Group 2 (35.73 ± 7.62 minutes) compared to Group 1 (47.40 ± 9.96 minutes) (P < 0.001). Fluoroscopy time was also shorter in Group 2 (45.92 ± 6.08 seconds) compared to Group 1 (54.02 ± 5.94 seconds) (P < 0.001). Incision length was reduced in Group 2 (9.21 ± 1.41 centimeters) compared to Group 1 (12.96 ± 1.68 centimeters) (P < 0.001). Blood loss was lower in Group 2 (187.50 ± 32.00 milliliters) than in Group 1 (208.65 ± 49.12 milliliters) (P < 0.05). There were no significant differences between the groups in fracture union time, hospital stay, fracture union weeks, or postoperative blood transfusion rates.

Conclusions: Proximal femoral nailing without distal locking offers shorter operative times, reduced fluoroscopy exposure, and lower blood loss and complications, making it a viable option for treating stable intertrochanteric fractures.

Keywords: complications; distal locking; distal unlocking; intertrochanteric fractures; intramedullary nail.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Intraoperative skin incision length, determination of blood loss and application of reduction and fixation under fluoroscopy.
Figure 2.
Figure 2.
Preoperative and postoperative anteroposterior and lateral views of a 77-year-old female patient with an OTA 31 A1-A2 classification fracture in the distal unlocking group.
See this image and copyright information in PMC

References

    1. Li X, Zhang L, Hou Z, et al. Distal locked and unlocked nailing for perthrochanteric fractures--a prospective comparative randomized study. Int Orthop. 2015;39(8):1645-1652. - PubMed
    1. Caiaffa V, Vicenti G, Mori C, et al. Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study. Injury. 2016;47(Suppl 4):S98-S106. - PubMed
    1. Kane PM, Vopat B, Paller D, Koruprolu S, Born CT. Effect of distal interlock fixation in stable intertrochanteric fractures. Orthopedics. 2013;36(7):e859-864. - PubMed
    1. Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. J Int Med Res. 2009;37(4):1057-1064. - PubMed
    1. Pascarella R, Fantasia R, Maresca A, et al. How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the gamma nail system. Musculoskelet Surg. 2016;100(1):1-8. - PubMed

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