Effect of PFNA main nail length on the reduction quality,surgical trauma level,and postoperative stability in patients with type 31-A3.1-A3.3 intertrochanteric femoral fracture

XIAO Xiao; LIU Shuaiyin; ZHANG Xiaolong; WANG Yafei; LI Yunhua

doi:10.3969/j.issn.1002-3429.2026.02.009

Abstract：Objective To investigate the effect of different main nail lengths of the proximal femoral nail antirotation(PFNA)in the treatment of patients with type 31-A3.1-A3.3 intertrochanteric femoral fracture(IFF).Methods A prospective study was conducted on 150 patients with type 31-A3.1-A3.3 IFF admitted from September 2022 to October 2024.These patients were divided into a long nail group and a short nail group based on a random number table method,with 75 patients in each group.The long nail group received the extended-length main nail for PFNA,while the short nail group received the standard-length main nail for PFNA.The perioperative indicators,fracture healing time,duration of complete weight-bearing,duration of operation,reduction quality,postoperative stability,surgical trauma stress factors[superoxide dismutase(SOD),angiotensin Ⅱ(Ang Ⅱ),norepinephrine(NE)],hip joint mobility[hip flexion-extension range of motion(ROM),internal-external rotation ROM of the hip],hip joint function,and complications were compared between the two groups.Results Compared with the short nail group,the duration of operation,length of hospitalization,blood loss,and intraoperative fluoroscopy frequency of the long nail group were longer or more,while duration of complete weight-bearing and fracture healing time were shorter(P＜0.05).There was no significant difference in the quality of reduction between the two groups(P＞0.05).The postoperative stability of the long nail group was better than that of the short nail group(P＜0.05).On the 1st and 3rd day after operation,SOD in the long nail group was lower than that in the short nail group,while Ang Ⅱ and NE were higher than those in the short nail group(P＜0.05).There was no significant difference in hip flexion and hip internal-external rotation ROM between the two groups at 3 and 6 months after operation(P＞0.05).The excellent and good rate of hip joint function in long nail group[98.67％(74/75)]was higher than that in short nail group[89.33％(67/75)](P＜0.05).There was no significant difference in the total incidence of complications between the long nail group[1.33％(1/75)]and the short nail group[2.67％(2/75)](P＞0.05).Conclusion Compared with standard-length main nail for PFNA,the extended-length main nail for PFNA in the treatment of patients with type 31-A3.1-A3.3 type IFF can promote fracture healing,improve postoperative stability,improve hip function,and has good safety;however,it is associated with greater surgical trauma and a slower perioperative recovery.