Publication:

Comparison of clinical and radiological outcomes of a proximal femoral nail with a helical screw versus a proximal femoral nail with two screws in elderly patients with intertrochanteric femur fractures

Background Intertrochanteric femur fractures in the elderly carry high morbidity and mortality rates, while the Proximal Femoral Nail (PFN) is a standard treatment, debate persists regarding the optimal screw configuration. This study compares the clinical and radiological outcomes of the helical blade versus the two-screw PFN in elderly patients with unstable intertrochanteric fractures.

Methods A prospective observational study was conducted on 70 patients aged >60 years with unstable intertrochanteric fractures. Patients were randomized into two groups (n=35 each). Functional outcomes were assessed using the Harris Hip Score (HHS) and radiological union time was evaluated. Operative time and postoperative complications were also recorded.

Results The functional outcomes were comparable between the study groups, most patients demonstrated HHS scores greater than 80, suggestive of favorable functional recovery. A greater proportion of early unions (≤10 weeks) and fewer delayed unions (>16 weeks) were observed in the helical group compared to the 2-screw group. The mean duration of surgery was significantly lower in the helical group (37 minutes) compared to the 2-screw group (45 minutes). Complications  occurred in 10 out of 70 patients, a comparatively better complication profile with the helical blade (3 patients) than 2 screw (7 patients) was observed.

Conclusions Both the helical blade and two-screw are effective. However, the helical blade offers distinct advantages including shorter operative time, faster radiological union, and a lower complication profile, making it a preferable option for early mobilization in elderly patients.