Comparison of two methods of locating proximal femoral nail anti-rotation in the treatment of femoral intertrochanteric fractures

BACKGROUND: To compare the efficacy of three-point locating versus routine locating techniques for implanting helical blades for proximal femoral nail anti-rotation-II in the treatment of trochanteric fractures. METHODS: From January 2010 to June 2013, 90 patients with intertrochanteric fractures were surgically treated, including 48 males and 42 females with an average age of 70.5 ± 7.2 years. According to the AO classification, there were 45 cases of A2.1, 35 cases of A2.2, and 10 cases of A2.3. Based on locating techniques, the 90 patients were divided into two groups: the three-point group and the routine group, with 45 patients in each group. All operations were performed by the same group of surgeons using proximal femoral nail anti-rotation (PFNA); the helical blade was inserted into the femoral neck with the three-point locating technique or by the usual method according to treatment group. Several figures including total operation time, elapsed time for implanting the helical blade, intraoperative blood loss, X-ray exposure time, and tip-apex distance (TAD) were measured and compared. RESULTS: The three-point group was significantly superior as compared to the routine group in terms of total operation time [(59.34 ± 9.42) min vs (67.61 ± 12.63) min, P < 0.01], elapsed time for implanting the helical blade [(4.58 ± 1.25) min vs (7.82 ± 2.19) min, P < 0.01], intraoperative blood loss [(92.78 ± 34.09) ml vs (154.01 ± 39.10) ml, P < 0.01], X-ray exposure time [(8.84 ± 1.45) vs (14.62 ± 2.91), P < 0.01], and tip-apex distance [(16.78 ± 1.55) mm vs (21.91 ± 3.01) mm, P < 0.01]. Among the 90 patients, 80 were followed up for an average time of 12 months (10–15 months), including 42 patients who were part of three-point group and 38 patients who were part of the routine group. No spiral blade cut was found on the femoral head in any patient in the three-point group, whereas it occurred in 2 patients in the routine group 1 month after surgery. However, there was no significant difference in the Harris score between the two groups 6 months after the operation. CONCLUSION: The three-point locating method is faster and more accurate than the routine locating method.