[Comparison of effectiveness of long and short proximal femoral nail anti-rotation in treatment of type A2.3 intertrochanteric fracture of femur].

Objective: To compare the effectiveness of long and short proximal femoral nail anti-rotation (PFNA) in the treatment of type A2.3 intertrochanteric fracture of femur (IFF).
Methods: The clinical data of 54 patients with type A2.3 IFF admitted between January 2020 and December 2022 were retrospectively analyzed. According to the length of PFNA nail used in the operation, they were divided into long nail group (PFNA nail length>240 mm, 24 cases) and short nail group (PFNA nail length≤240 mm, 30 cases). There was no significant difference in baseline data such as gender, age, fracture side, body mass index, and time from fracture to operation between the two groups ( P >0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, intraoperative reduction quality score, fracture healing, and complications of the two groups were recorded and compared. Harris score was used to evaluate the hip function of patients at 1 year after operation. According to the relationship between the fracture line of type A2.3 IFF and the lesser trochanter, the two groups of patients were divided into type Ⅰ(the fracture line extends to the level of the lesser trochanter), type Ⅱ(the fracture line extends to less than 2 cm below the lesser trochanter), and type Ⅲ (the fracture line extends to more than 2 cm below the lesser trochanter), and the postoperative stability and internal fixator loosening of each subtype were evaluated.
Results: The operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency in short nail group were significantly less than those in long nail group ( P <0.05). There was no significant difference in the intraoperative reduction quality score between the two groups ( P >0.05). Patients in both groups were followed up 12-18 months, with an average of 13.5 months. The postoperative stability score of short nail group was significantly lower than that of long nail group ( P <0.05). The Harris score in the long nail group was significantly higher than that in the short nail group at 1 year after operation ( P <0.05), but there was no significant difference in Harris score grading between the two groups ( P >0.05). Complications occurred in 3 cases of the long nail group (including 1 case of coxa varus caused by external nail entry point and 2 cases of loose internal fixator), and 7 cases of the short nail group (including 1 case of coxa varus caused by external nail entry point and 6 cases of loose internal fixator). Neither group had any anterior femoral arch damage, there was no significant difference in the incidence of complications between the two groups ( P >0.05). The number of type Ⅲ patients was relatively small and not included in the statistics; there was no significant difference in the postoperative stability score and the incidence of internal fixator loosening between the long and short nail groups in type Ⅰ patients ( P >0.05). In type Ⅱ patients, the postoperative stability score and the incidence of internal fixation loosening in the long nail group were significantly better than those in the short nail group ( P <0.05).
Conclusion: Long PFNA fixation for type A2.3 IFF has longer operation time and more intraoperative blood loss, but the overall stability of fracture is better after operation. For type A2.3 IFF with fracture line extending to less than 2 cm below the lesser trochanter, long PFNA is used for fixation, although the surgical trauma is large, but the postoperative stability is better than that of short PFNA; for type A2.3 IFF with fracture line extending to the lesser trochanter, there is no significant difference in postoperative stability between long and short PFNAs.