Comparison of the Surgical Outcome of Intertrochanteric Fracture with Gamma Nail Insertion Through Inferior-Center and Center-Center Blade Entry Point; A Randomized Control Study

Introduction: Cephalomedullary nails (CMNs) are preferred over sliding hip screws (SHS) for treating intertrochanteric fractures (ITF) due to less intraoperative blood loss, operating time, varus collapse, and femoral shortening. However, the optimal blade position in the femoral head remains controversial despite its critical role in preventing complications. This study aims to determine the best blade position to enhance outcomes and reduce implant failure in ITF patients treated with CMNs. The purpose of this study was to determine the optimum helical blade position in intertrochanteric fractures fixed via cephalo-medullary nail. The results of this study will help orthopedic surgeons choose the best blade position in patients with ITF treated with CMN to reduce implant failure.Methods: 167 patients with intertrochanteric fractures were randomly assigned to two study groups. The helical blade was applied inferior-center (I-C) in the first group, and the second group applied center-center (C-C). Tip-apex distance (TAD), neck shaft angle (NSA), and femoral neck axis length (FNAL) were measured in early postoperative and six months postoperative.Results: In the C-C group, the immediate and six-month postoperative NSA was 132.9 ± 5.72 and 131.1 ± 5.78, TAD was 18.7 ± 5.39 and 18.8 ± 5.8, and FNAL was 114.7 ± 13.6 and 110.7 ± 11.1, respectively. In the I-C group, the immediate and six-month postoperative NSA was 134.7 ± 5.19 and 131.6 ± 5.76, TAD was 20.4 ± 6.4 and 20.5 ± 8.24, and FNAL was 112.1 ± 10.5 and 108.5 ± 12.6, respectively.Conclusion: Regarding radiologic parameters, the I-C helical blade position achieved the same results as the C-C blade position.

Comparison of the Surgical Outcome of Intertrochanteric Fracture with Gamma Nail Insertion Through Inferior-Center and Center-Center Blade Entry Point; A Randomized Control Study Keywords:

Hip fracture , Intertrochanteric fractures , Cephalomedullary nail , Neck shaft angle