A Comparison of Helical Blade and Lag Screw Fixation in the Treatment of Intertrochantic Hip Fractures With Cephalomedullary Nails

Thursday, October 19, 2023

9:26 AM – 9:32 AM PST

Location: 4B

Presenting Author / Corresponding Author(s)

Garrett Cavanaugh, MD

Attending Orthopaedic Trauma Surgeon
Einstein Medical Center Philadelphia
Philadelphia, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

NV

Noelle L. Van Rysselberghe, MD

Fellow
Harborview Medical Center
Stanford, California, United States
CG

Christian A. Gonzalez, BS

University of Nevada, Reno School of Medicine
University of Reno, Nevada School of Medicine
Reno, Nevada, United States
MW

Mathew James Whittaker, MD

Stanford Orthopaedic Surgery
JM

John B. Michaud, BA

Stanford University
Garrett W. Esper, BA

NYU Langone Orthopedic Hospital
NYU Langone Health, New York, United States
HP

Harin Parikh, MD
JW

Juntian Wang, MD

Cedars Sinai Medical Center
AR

Abrianna Robles, BS

Cedars Sinai Medical Center
AH

Andrea Horne, CCRP
AA

Arya Amirhekmat, BS
EB

Eleni Berhaneselase, BA

University of California, San Francisco
NM

Natalie Marie Marenghi, MD

Atrium Health Wake Forest Baptist
DN

Daniel Ngo, BA

McGovern Medical School
MM

Marisa McDow, BS
CH

Christopher G. Herbosa, BS

Medical Student
Washington University School of Medicine in St. Louis
NYU Langone
MD

Maricela Diaz, MA

Indiana University
UE

Uchechukwu Emili, MD
ZL

Zachary Lim, MD

UC San Francisco Medical Center, San Francisco, CA
DP

Dmitry Pokhvashchev, MD, PhD
AM

Aden Malik, MD

UC San Francisco Medical Center, San Francisco, CA
EO

Edmond F. O'Donnell, MD, PhD
MJ

Muhammad Umar Jawad, MD
SC

Sean T. Campbell, MD
ML

Milton TM Little, MD (he/him/his)

Assistant Professor
Cedars-Sinai Medical Center
Cedars Sinai Medical Center
Los Angeles, California, United States
WV

Walt W. Virkus, MD

Indiana University
Philipp Leucht, MD

Associate Professor
NYU Langone Orthopedics
New York, New York, United States
MG

Matthew R. Garner, MD

Director of Fracture Care Services
UPMC, Central PA
Hummelstown, Pennsylvania, United States
Mark A. Lee, MD (he/him/his)

UC Davis
Sacramento, California, United States
John A. Scolaro, MD, MA (he/him/his)

Associate Professor
University of California, Irvine
Orange, California, United States
Marschall Berkes, MD

St Louis, Missouri, United States
Saam Morshed, MD, PhD, MPH (he/him/his)

Professor of Orthopaedic Surgery, Epidemiology and Biostatistics
University of California, San Francisco
University of California, San Francisco
San Francisco, California, United States
Stephen J. Warner, MD, PhD

University of Texas at Houston, McGovern Medical School
Houston, Texas, United States
PP

Paul William Perdue, MD

Virginia Commonwealth University
VCU
EC

Eben Carroll, MD
JL

Justin Lucas, MD

Santa Clara Valley Medical Center
Julius A. Bishop, MD

Associate Professor
Stanford University School of Medicine
HG

Henry Goodnough, MD, PhD

Faculty
Stanford
Redwood City, California, United States
Michael J. Gardner, MD (he/him/his)

Professor of Orthopaedic Surgery
Stanford University, California, United States

Purpose: The objective was to compare failure rates of helical blade versus lag screw fixation in intertrochanteric femur fractures treated with the Trochanteric Fixation Nail-Advanced (TFNA).

Methods: Data from 13 Level I trauma centers were retrospectively analyzed. Patients with intertrochanteric femur fractures (AO/OTA 31A1-A3) treated between January 2014 and May 2021, inclusive, with TFNA were identified. Pathologic fractures and those with less than 3 months of follow-up were excluded. Rates of fixation failure, reoperation, and nonunion were compared when a lag screw was used vs a helical blade. Fixation failure was defined as perforation of the femoral head with the helical blade or lag screw due to collapse or varus angulation.

Results: A total of 767 cases were analyzed. 454 (59.2%) were female and median age was 77 years. 458 (59.7%) were treated using a lag screw and 309 (40.3%) using a helical blade. Fixation failure occurred in 23 (3%) total cases: 11 (2.4%) in the lag screw group versus 12 (3.9%) in the helical blade group (P = 0.238). Reoperation was needed in 45 (5.9%) cases: 21 (4.6%) in the lag screw group versus 24 (7.8%) in the helical blade group (P = 0.066). Nonunion occurred in 13 (1.7%) cases: 9 (2.0%) in the lag screw group versus 4 (1.3%) in the helical blade group (P = 0.48).

Conclusion: No statistically significant differences were observed in rates of fixation failure, reoperation or nonunion between intertrochanteric fractures when a TFNA lag screw was used versus a TFNA helical blade. Reoperation rates approached statistical significance, occurring in 7.8% of cases where a helical blade was used compared to 4.6% of cases where a lag screw was used. While earlier reports have suggested a higher rate of fixation failure with use of the helical blade, this study supports more recent findings demonstrating no significant difference in early outcomes between the use of a helical blade and lag screw.