PFNA combined with anterolateral reconstruction plate versus InterTAN in the treatment of elderly patients with AO/OTA A3.3 intertrochanteric fractures
Xia Guofeng
Zhang Rong
Liu Qi
Li Xiaoliang
Sun Peifeng
Abstract：Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)combined with an anterolateral reconstruction plate and the InterTAN intramedullary nailing in the treatment of elderly patients with AO/OTA A3.3 intertrochanteric fractures of the femur.Methods This retrospective analysis was conducted on clinical data of patients with AO/OTA A3.3 intertrochanteric femoral fractures treated with either PFNA com-bined with lateral wall reconstruction or InterTAN at our department from Jan.2018 to Dec.2023.A total of 81 pa-tients,37 males and 44 females,aged 60-81(mean 72.5)years,were enrolled.The injury causes were road traffic accidents in 47 cases,and falls in 34 cases.According to the treatment they received,patients were divided into lat-eral wall reconstruction group(36 cases)and InterTAN group(45 cases).In the former,there were 16 males and 20 females of 60-81(mean 73.2)years,who received PFNA fixation with lateral wall reconstruction(17 left side and 19 right).In the latter,there were 21 males and 24 females of 61-78(mean 71.9)years,who received Inter-TAN intramedullary nail fixation(24 left side and 21 right).Comparisons between the two groups included opera-tion time,intraoperative blood loss,off-bed activity time,full weight-bearing time,fracture healing time,tip-apex dis-tance(TAD),Harris hip score(HHS)and Parker-Palmer mobility score(PPMS)at 12 months postoperatively,and complications within 1 year after surgery.Results The lateral wall reconstruction group exhibited a longer op-erative time(min,101.7±16.7 vs.89.3±12.5)and more intraoperative blood loss(mL,123.5±18.2 vs.112.1±21.8),compared to the InterTAN group.However,it demonstrated significant advantages in postoperative recovery parameters:earlier off-bed activities(d,14.3±1.2 vs.18.6±1.3)and weight-bearing(week,13.6±3.4 vs.15.5±3.5),faster fracture healing(week,11.8±1.2 vs.12.7±1.1),and higher HHS(91.6±7.5 vs.84.3±8.8)and PPMS(8.5±1.7 vs.7.4±1.7)at 12 months,all revealing statistically significant differences(P<0.05).Both groups showed progressive shortening of femoral neck length at 2 and 12 months postoperatively compared to immedi-ate postoperative measurements(2 d).Notably,the lateral wall reconstruction group demonstrated significantly shor-ter femoral neck dimensions at both follow-up intervals(mm,43.8±2.1 vs.44.6±1.0 at 2 months;42.6±1.9 vs.43.7±0.9 at 12 months)compared to the InterTAN group(P<0.05).Conclusion Compared with InterTAN fixa-tion alone,the use of PFNA and lateral wall reconstruction plate for the treatment of A3.3 femoral trochanteric frac-tures results in earlier weight-bearing exercise,quicker fracture healing,and better hip joint functional recovery.
Keywords：Intertrochanteric fracturesInterTANReconstruction of the lateral wallProximal femoral nail antirotation
Publication Date：2025-12-15
Online Publishing Date：2026-01-05(First online date of this platform, not the publication date of the document)
Pages：7( 921-927 )