Comparison of antirotation proximal femoral nail and talon locking nail systems in the treatment of intertrochanteric fractures: functional and cost-effectiveness outcomes

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2025-09-10 DOI:10.1007/s00402-025-06065-7

İsmail Güzel, İbrahim Ulusoy, Mehmet Fırat Tantekin, Mehmet Yılmaz, Aybars Kıvrak

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Abstract

Purpose

This study aimed to compare the clinical outcomes and cost-effectiveness of two widely used intramedullary fixation systems—the Proximal Femoral Nail Antirotation (PFNA) and the Proximal Femoral Nail with Talon Locking System (PFN-TLS)—in the treatment of intertrochanteric femur fractures (ITFF).

Methods

A retrospective cohort study was conducted on 118 patients aged 65–90 years who underwent surgical treatment for ITFF using either PFNA (n = 53) or PFN-TLS (n = 65). All patients were followed for a minimum of 24 months. Preoperative functional evaluation was unavailable; outcomes were assessed at 24 months postoperatively. Surgical parameters, complication and revision rates, functional outcomes (Harris Hip Score [HHS], Visual Analog Scale [VAS], and SF-36), and health-economic indicators (Quality-Adjusted Life Years [QALY], Incremental Cost-Effectiveness Ratio [ICER]) were evaluated. Binary logistic regression analysis was performed to determine independent predictors of favorable functional outcomes.

Results

The PFN-TLS group demonstrated significantly shorter surgical duration, reduced incision length, and lower fluoroscopy exposure (p < 0.05). At the 24-month follow-up, HHS was significantly higher in the PFN-TLS group (82.7 ± 7.4) compared to the PFNA group (76.4 ± 8.1; p = 0.001). VAS and SF-36 scores were also higher, although not statistically significant. Revision rates showed a non-significant trend favoring PFN-TLS. QALY gains were slightly higher in the PFN-TLS group (0.530 vs. 0.449), with a lower cost per QALY ($1,637.93 vs. $1,863.22). PFN-TLS use was independently associated with favorable functional outcomes (OR: 2.62; 95% CI 1.23–5.58; p = 0.013).

Conclusion

Both PFNA and PFN-TLS are effective options for the management of ITFF. However, PFN-TLS may offer additional clinical and economic benefits, including improved functional outcomes and greater cost-efficiency. Findings should be interpreted with caution due to the retrospective design. Prospective, randomized studies are needed to validate these results and guide implant selection in clinical practice.

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反旋转股骨近端钉与爪锁钉系统治疗股骨粗隆间骨折的比较：功能和成本效益结果

目的本研究旨在比较两种广泛应用的髓内固定系统——股骨近端防旋钉（PFNA）和股骨近端带爪锁系统（PFN-TLS）治疗股骨粗隆间骨折（ITFF）的临床疗效和成本效益。方法回顾性队列研究118例65 ~ 90岁的ITFF患者，采用PFNA（53例）或PFN-TLS（65例）进行手术治疗。所有患者至少随访24个月。术前无法进行功能评估；术后24个月评估结果。评估手术参数、并发症和翻修率、功能结局（Harris髋关节评分[HHS]、视觉模拟量表[VAS]和SF-36）和健康经济指标（质量调整生命年[QALY]、增量成本-效果比[ICER]）。进行二元逻辑回归分析以确定良好功能预后的独立预测因素。结果PFN-TLS组手术时间明显缩短，切口长度明显缩短，透视暴露明显降低（p < 0.05）。24个月随访时，PFN-TLS组HHS（82.7±7.4）明显高于PFNA组（76.4±8.1,p = 0.001）。VAS和SF-36评分也较高，但无统计学意义。修正率显示PFN-TLS无显著趋势。PFN-TLS组的QALY收益略高（0.530对0.449），每个QALY的成本较低（1,637.93美元对1,863.22美元）。PFN-TLS的使用与良好的功能预后独立相关（OR: 2.62; 95% CI 1.23-5.58; p = 0.013）。结论PFNA和PFN-TLS是治疗ITFF的有效选择。然而，PFN-TLS可能提供额外的临床和经济效益，包括改善的功能结果和更高的成本效益。由于采用回顾性设计，结果应谨慎解释。需要前瞻性的随机研究来验证这些结果，并指导临床实践中种植体的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).