Effects of intramedullary nail and locking plate on joint function and biomechanical indexes in patients with intertrochanteric femoral fractures

HU Zhenning; WU Haitao; YUAN Haisheng

doi:10.3969/j.issn.1674-666X.2025.03.006

Abstract：Objective To compare the differences of clinical efficacy,biomechanical indicators and safety between intramedullary nail and locking plate in the treatment of intertrochanteric femoral fractures.Methods A total of 86 patients with intertrochanteric femur fractures admitted to Zhenping County Maternal and Child Health Hospital from May 2023 to November 2024 were enrolled.Using a randomized digital table method,they were divided into two groups,intramedullary nail group(n=43)and locking plate group(n=43).The study compared preoperative and postoperative Harris score,range of motion(ROM)of hip joint,and bone mineral density(BMD)of the proximal femur between the two groups.Finite element analysis was conducted to evaluate stress distribution at the fracture site,and the complication rates were recorded.According to Evans classification,patients in two groups were divided into stable fracture subgroup(each,25 cases)and unstable fracture subgroup(each,18 cases),the above indicators of patients in the subgroups were compared and analyzed respectively.Results At 3 and 6 months postoperatively,the Harris score of hip joint in the intramedullary nail group was higher than that in the locking plate group(P<0.05).At 6 months postoperatively,the intramedullary nail group showed greater ROM in flexion,extension and other directions,as well as higher proximal femoral BMD when compared to those in the locking plate group,while both maximum and average stress at fracture sites were lower than those in the locking plate group(P<0.05).The complication rate in the intramedullary nail group was lower than that in the locking group(9.30%vs 23.26%),but the difference between two groups showed no statistically significance(P<0.05).For both stable and unstable fracture subgroups,the intramedullary nail group showed higher Harris scores,proximal femoral BMD and lower maximum,average stress than those in the locking plate group at 6 months postoperatively(P<0.05).Conclusion Iintramedullary nail internal fixation is a safe and effective treatment option for stable and unstable intertrochanteric fractures of the femur,which is superior to locking plate fixation in terms of joint function recovery and biomechanical stability.