title: Influence of different great trochanteric entry points on the outcome of intertrochanteric fractures: a retrospective cohort study.
abstract: The Proximal Femoral Nail Antirotation (PFNA) system for treatment of intertrochanteric fractures is currently widely applied worldwide. However, even though the PFNA has produced good clinical outcomes, a poor introduction technique with an inappropriate entry point can cause surgical complications. Some researchers suggest improving clinical outcomes by modifying the entry point, but no research has focused on this issue. The purpose of the present study is to compare the clinical and radiological outcomes of two different trochanteric entry points for the treatment of intertrochanteric fractures using the PFNA system.
  
  
  
  From May 2010 to October 2015, a total of 212 elderly patients with intertrochanteric fractures who were treated with the PFNA-II system were included into this retrospective cohort study. Group LA (98 patients) was treated using a lateral anterior trochanteric entry point, and group MP (114 patients) was treated using a medial posterior trochanteric entry point. All patients underwent follow-up assessments at 1, 3, 6, and 12 months after surgery. Radiographic evaluation was based on the impingement, tip-apex distance (TAD) and the position of the helical blade within the femoral head. Clinical evaluation was based on the surgical time, fluoroscopy time, blood loss, hospital stay, visual analogue scale (VAS), thigh pain, and Harris hip score.
  
  
  
  The impingement was significantly reduced (P = 0.011) in group MP. The helical blade positions were significantly lower (P = 0.001) in group MP. The TADs in group LA (22.40 ± 4.43) and group MP (23.39 ± 3.60) were not significantly different (P = 0.075). The fluoroscopy time of group LA (53.26 ± 14.44) was shorter than that of group MP (63.29 ± 11.12, P = 0.000). Five iatrogenic lateral proximal fractures and 3 helical blade cutouts occurred in group LA, but none occurred in group MP. At 1 and 3 months postoperation, the Harris hip scores were significantly higher in group MP (P = 0.001 and P = 0.000, respectively), and the VAS scores were lower (P < 0.05).
  
  
  
  The medial posterior trochanteric entry point achieved excellent nail and helical blade position, reduced surgical complications, and enabled early hip function recovery but required longer fluoroscopy time than the lateral anterior trochanteric entry point.
authors.affiliation: Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China. panshuo917@163.com.
authors.forename: Shuo
authors.initials: S
authors.lastname: Pan
authors.affiliation: Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China.
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Feng
authors.affiliation: Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China.
authors.forename: Hui-Jun
authors.initials: HJ
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, Shijiazhuang No. 1 Hospital, NO.36 Fanxi Road, Shijiazhuang, 050011, Hebei, China.
authors.forename: Zhi-Guang
authors.initials: ZG
authors.lastname: Tian
authors.affiliation: Judicial Authentication Center of The People's Procuratorate of Hebei Province, Shijiazhuang, 050011, Hebei, China.
authors.forename: Chun-Guang
authors.initials: CG
authors.lastname: Lou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Intertrochanteric hip fracture; PFNA; Trochanteric entry point