Retrospective Comparative Study of the Intraoperative Fracture Gap Compression in the Treatment of Intertrochanteric Fracture Using Proximal Femoral Nail Antirotation

Purpose: Intertrochanteric fractures can be treated using proximal femoral nail antirotation (PFNA). This study examined the clinical and radiological results of the intraoperative fracture compression. Materials and Methods: Ninety-four patients underwent intraoperative compression (Group I), and 88 patients underwent natural sliding only (Group II). The patients were followed-up for more than two years. All patients met the following seven conditions: (1) AO/OTA 31-A1, A2 type intertrochanter fracture, (2) availability of compression of more than one cortical bone in the anterior or medial region of the fracture site under the preoperative imaging test, (3) Singh index grade ≥3, (4) blade position: center-center, center-inferior, (5) tip-apex distance < 25 mm, (6) reduction status of good or very good, and (7) positive or neutral medial cortical support position with slightly valgus reduction. Results: A slight tendency toward significant differences in acute phase pain between the two groups was observed at six weeks postoperatively (p=0.073). Twenty-four months after surgery, lateral extension of the PFNA helical blade between the two groups showed significant differences (p=0.017). Fracture gaps measured immediately after surgery showed significant differences (p=0.001), and a clear tendency for a significant difference in the average fracture union time was found (p=0.065). Conclusion: Intraoperative fracture compression, intraoperative fracture compression appears beneficial to achieve a successful union of trochanteric fractures provided that all conditions are met to apply the method safely.