Maintenance of Postoperative Reduction in Trochanteric Fracture Fixation: A
Prospective Comparison of Helical Blades and Screws in a Single Cephalomedullary
Nailing System
#MMPMID41112697
Wittauer M
; Henry J
; Jones CW
; Yates PJ
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41112697
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BACKGROUND: Cephalomedullary nailing systems, such as the trochanteric femoral
nail advanced (TFNa), are standard of care for trochanteric fractures. The TFNa
system allows for the use of either a helical blade or a lag screw for femoral
neck fixation, but there is ongoing debate regarding which component provides
superior outcomes. The aim of this study was to compare the performance of these
two components in maintaining fracture reduction and preventing mechanical
complications. METHODS: A prospective cohort study enrolled 201 patients aged 50
years or older with type 31A1-31A2 (pertrochanteric) and 31A3 (intertrochanteric)
fractures, as classified by the Arbeitsgemeinschaft für Osteosynthesefragen
(AO)/Orthopaedic Trauma Association (OTA), all treated with the short TFNa.
Patients were allocated to helical blade (n = 101) or lag screw (n = 100)
cohorts. Radiographic outcomes-changes in the tip-apex distance (TAD), femoral
neck shortening, and changes in the neck-shaft angle (NSA)-were assessed at 3
months. Secondary outcomes included mechanical complications, patient-reported
outcome measures (PROMs), and number of patients deceased at 1-year follow-up.
RESULTS: Radiographic outcomes among pertrochanteric fractures-femoral neck
shortening, NSA, and TAD changes-were comparable between cohorts. Owing to
limited power, no conclusions could be drawn for intertrochanteric fractures.
Mechanical complication rates were similar between groups (blades: 4.0%, screws:
6.0%), with no significant association between femoral neck component and
complications. A postoperative TAD greater than 20 mm was significantly
associated with increased mechanical complications (odds ratio = 4.4, p = 0.023).
PROMs improved similarly in both groups over time, and the number of patients
deceased within 1 year after the operation was identical in both cohorts.
CONCLUSIONS: The findings indicate that helical blades and lag screws offer
comparable stability in pertrochanteric fracture fixation within the TFNa system.
Femoral neck component choice does not significantly affect mechanical
complication rates or clinical outcomes. Rather, optimal implant placement and a
postoperative TAD under 20 mm are key to successful outcomes. These results
support prioritizing surgical precision over component selection in managing
pertrochanteric fractures. LEVEL OF EVIDENCE: Level III. See Instructions for
Authors for a complete description of levels of evidence.
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