Comparative Study between Treatment Outcomes in using Helical Blade and Telescopic Lag Screw in Proximal Femoral Nail for the Treatment of Unstable Intertrochanteric Fractures

Abstract

Intertrochanteric fractures are common in the elderly population and present significant challenges due to associated comorbidities. Operative fixation techniques have evolved over the decades, with proximal femoral nailing (PFN) being a preferred method. This study compares the outcomes of PFN using a helical blade versus a telescopic lag screw. Conducted at the Department of Orthopaedics, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India for a duration of 18 months from January 2023 to June 2024. A total of 50 patients with intertrochanteric femur fractures were included in the study and divided into two groups: Group A (PFN with helical blade) and Group B (PFN with telescopic lag screw). Patients were assessed based on parameters such as time for union, neck shaft angle, Tip Apex Distance (TAD), Harris Hip Score, and complications. Statistical analysis was performed using SPSS software. Neck Shaft Angle was normal in 72% of Group A and 68% of Group B, with no significant difference, Tip Apex Distance (TAD) was higher in Group A at 4, 12, and 24 weeks follow-up, with statistical significance (p<0.05). Harris Hip Score was significantly higher in Group B at 4 weeks follow-up (p=0.014), but no significant difference at 12 and 24 weeks. 16% of patients in Group A experienced screw cut-out, which was statistically significant. One patient in each group experienced screw back-out. PFN with telescopic lag screw demonstrated superior outcomes compared to PFN with helical blade, particularly in terms of lower Tip Apex Distance, increased complication rates such as screw backout, screw cut out and higher Harris Hip Scores at early follow-up. A high Tip Apex Distance correlates with an increased risk of device cut-out from the femur head.

Keywords :Unstable  intertrochanteric fractures; Helical blade; Telescopic Lag screw; Tip Apex distance; Harris Hip Score