• J FeldinszkÁ, P Jacko, J Barinka, M Kilian, and P Šimko.
• Klinika úrazovej chirurgie SZU a UNB, Nemocnica akademika Ladislava Dérera, Bratislava.
• Acta Chir Orthop Traumatol Cech. 2020 Jan 1; 87 (4): 268-272.

AbstractPURPOSE OF THE STUDY Surgical treatment of trochanteric fractures with intramedullary nailing still remains controversial as to which nail design is the best with no postoperative complications. The purpose of this study was to provide a comparative evaluation of complications in the treatment of trochanteric fractures using 2-screw proximal femoral nail versus proximal femoral anti-rotational blade nail. MATERIAL AND METHODS A retrospective review was conducted between March 2013 and March 2019. The study included 519 patients (358 females and 161 males) treated surgically for trochanteric fractures. The mean age was 79.8±12.0 (24-100) years. A1.2 type of fracture occurred in 153 (29.5%) cases, A1.3 type in 155 (29.9%), A 2.2 type in 90 (17.4%), A2.3 type in 95 (18.3%), A3.1 type in 11 (2.1%), A3.2 type in 7 (1.3%) and A3.3 type in 8 (1.5%) cases. Patients were treated either by 2-screw nail PFN (393 patients (75.7%) or by anti-rotational blade nail PFNA (126 patients (24.3%). RESULTS Our primary objective was to evaluate the implant related complications (e.g. cut-out, back-out, irritation, peri-implant fractures). Other complications (infection) and revision surgeries were also recorded. Complications were observed in 38 (9.7%) patients with PFN nail and 7 (5.6 %) patients with PFNA blade nail (p = 0.15). Screw back-out (n = 11) and cut-out (n = 11) were the most frequent complications in patients treated by 2-screw PFN nail and occurred in 5.6%. In the PFNA group, cutout occurred in 1.6% (n = 2) of cases while no cases of back-out were reported. Infection (n=3) was the most common complication in the latter group and represented 2.4%. In the PFN group the infection rate was 2.3% (n = 9). There were no statistically significant differences between both the groups considering implant-related complications (p = 0.14) and infections (p = 1.0). Revision surgery was performed in 33 patients (66.7%). DISCUSSION Biomechanical studies of intramedullary nails suggest good results with minimal complications if a two-screw implant is used. When antirotational blade is used, compression of spongiosis around blade is observed, which increases stability, especially in an osteoporotic bone. In our study, complications in these two types of nails were retrospectively compared. Considered as the limitation of our study is the retrospective nature of evaluation, which made it impossible the create two study groups with equal or similar number of patients, to follow up the patients postoperatively for a long period of time and to evaluate fracture union and limb function. CONCLUSIONS In our study no statistically significant difference in postoperative mechanical and infectious complications was confirmed between the 2-screw proximal femoral nail and the proximal femoral nail with antirotational blade. We have arrived at the conclusion that both types of nails are equivalent in treating trochanteric fractures. Key words: intramedullary nail, screw, blade, trochanteric fracture, complication.

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