Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture

Purpose: This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125 ° and 130 ° in patients with intertrochanteric fractures. Materials and Methods: From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evalu-ated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125 ° angled PFNA-II and 130 ° angled PFNA-II, respectively. The clinical performance was eval-uated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared. Results: The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125 ° angled PFNA-II and 130 ° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125 ° angled PFNA-II and 130 ° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012). Conclusion: The operation with the 125 ° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130 ° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.