Treatment outcomes of femur proximal fracture fixed with PFNA and parametres influencing heali̇ng

Treatment Outcomes of Femur Proximal Fractures Fixed with PFNA and Parameters Influencing Healing Intramedullary nailing is an effective treatment for femur intertrochanteric fractures, providing a mechanically and biologically advantageous environment for fracture healing. This method stabilizes the bone fragments via a nail placed within the medullary canal of the femur. This retrospective, single-center study aims to evaluate the factors affecting fracture healing following osteosynthesis with intramedullary nails in femur intertrochanteric fractures. The efficacy of stabilization techniques is closely related to implant positioning, reduction quality, and patient-specific anatomical parameters. In this context, parameters such as tipapex distance, Baumgaertner criteria, collodiaphyseal angle, and Parker ratio were assessed. The study includes records of 108 patients treated at Akdeniz University Hospital's Orthopedics and Traumatology Department between January 2019 and June 2024. Of these, 49 patients had deceased, and 9 did not follow-up, leaving 50 patients included in the analysis. Radiographs taken at 3, 6, and 12 months postoperatively were evaluated separately, and healing was assessed using the RUSH score. A tip-apex distance <25 mm was significantly associated with a lower rate of reduction loss. Among patients with reduction loss, 60% exhibited poor Baumgaertner criteria, indicating a statistically significant relationship between these variables. Low Parker ratio and fracture types AO 31A1–31A2 significantly reduced reduction loss rates. No statistically significant differences were found regarding Dorr index or postoperative collodiaphyseal angle in relation to reduction loss. The presence of diabetes did not significantly affect fracture healing. In conclusion, accurate radiologic assessment of parameters is crucial for improving surgical outcomes in intertrochanteric femur fractures. Tip-apex distance, Parker ratio, and Baumgaertner criteria serve as guiding metrics in surgical planning and postoperative follow-up. 79 Key Words: Femur intertrochanteric fracture, tip-apex distance, Baumgaertner criteria, Parker ratio.