Comparison of reduction and success criteria of unlocked and locked blade proximal femoral nail antirootation (PFNA) implants applied in the treatment of trocanteric fractures

Aim: The aim of our study is to compare the reduction quality and treatment results of locked and unlocked blade-featured forms of PFNA application, which is widely preferred in the treatment of trochanteric fractures, in patients over 65 years of age, most of whom are osteoporotic, with similar age, gender, comorbidities, fracture type. Materials and Methods: The cases treated for trochanteric fracture in our clinic between January 2013 and January 2010 were retrospectively analyzed. Patients over 65 years of age who underwent surgical treatment with PFNA and were followed up for at least 1 year with similar age, gender, comorbidities and fracture type were randomly selected and two groups were formed as unlocked and locked blade PFNA patients. Cases who were treated conservatively, who underwent surgical treatment with plate screw and arthroplasty, and whose records could not be reached, were not included in the study. Cases in which PFNA with locked or unlocked blades were applied, additional diseases, fracture formation mechanism, fracture type, fracture classification, time between fracture occurrence and operation time, operation time, amount of bleeding, complications during surgery, reduction method, reduction quality, postoperative period. The need for intensive care, length of stay in the intensive care unit, length of hospital stay, postoperative radiological measurements, mobilization time with full weight, follow-up time, postoperative complications, Harris scaling, visual analog score and time of death were compared. The results were evaluated with the IBM SPSS 28 program. Results: 63 of 387 patients over 65 years of age who applied to our clinic with locked and unlocked blade PFNA as a result of trochanteric fracture were excluded from the study because of inaccessible or incomplete data, less than 1 year follow-up, and internal fixation with plate screw and arthroplasty. 314 trochanteric fractures of 314 cases with randomly applied unlocked (n=164) and locked (n=160) blades were included in the study, with similar parameters such as gender, age, additional comorbid conditions, fracture type, fracture formation mechanism. Bilateral trochanteric fractures were detected in 10 cases. There was no difference between the groups in terms of additional comorbid conditions (p=0.811). There were 132 stable 32 unstable fractures in the unlocked group and 132 stable 28 unstable fractures in the locked group, and there was no significant difference between them (p=0.545). The operation time was significantly longer in the locked group (mean 65.55 min) than the unlocked group (mean 45.79 min) (p=0.001). The amount of bleeding in the locked group (mean 111.19 ml) was higher than the unlocked group (mean 79.97 ml), and the difference was significant (p=0.001). There was no significant difference between the unlocked ((n)128 good, 28 acceptable, 8 bad) and locked ((n) 115 good, 32 acceptable, 13 bad) groups in terms of the quality of the reducer when the groups were classified as good, acceptable, and bad (p). =0.325). In the measurements made after the radiological imaging of the fracture, the Parker ratio AP in the locked group (median value 52.5) was higher than the unlocked group (median value 51.3), and the difference was significant (0.037). Other measurement data are type apex distance (median value unlocked=22.05 mm, locked=21.6mm), calcareous reference type apex distance (median value unlocked=27.68mm, locked=27.2mm) and cervical angle The difference (median value unlocked=2.35, locked=0.72) was significantly higher in the unlocked group than the locked group (p=0.049, p=0.042, p=0.006). While the visual analogue score was significantly higher in the locked group (median value 3.25) and unlocked group (median value 2.45) in the 6th week data (p=0.031), VAS 1st year (median value unlocked=1.58, locked=2) .28), Harris hip score at 6 weeks (median value unlocked=65.29, locked=64.52) and 1 year (median value unlocked=68.25, locked=68.79) there was no significant difference between the groups. (p=0.523, p=0.335, p=0.256). Postoperative complications were significantly higher in the locked group (p=0.002). Although nonunion in the locked group (n=10) was higher than in the unlocked group (n=3), there was no difference (p=0.087). The follow-up period was significantly longer in the unlocked group (mean 43.9 months) than in the locked group (mean 20.56 months) (p=0.001). Conclusion: The groups formed in our study, in which the locked and unlocked forms of the PFNA implant applied after a trochanteric fracture over 65 years of age were evaluated, did not differ significantly in terms of age, gender, comorbidities, mechanism of trauma and fracture type. There was no difference between the groups in terms of fracture type and classification. The results of the operation time and the amount of bleeding were lower in the unlocked group. The quality of reduction was similar in the groups. In radiological measurements, Parker ratio AP value was in the locked group; Type apex distance, calcar-reference type apex distance and cervical angle difference were higher in the unlocked group. There was no difference between the long-term results of the clinical satisfaction scores of the Harris hip score and the Visual Analogue score. Although nonunion was more common in the locked group, the difference was not significant. Postoperative complications were lower in the unlocked group. Follow-up time was higher in the unlocked group. In our study comparing the reduction quality of PFNA with unlocked blade and PFNA with locked blade in terms of surgical and clinical success, although the unlocked blade group was seen to be more successful, the patients were treated as a single individual with their comorbid conditions, fracture status, clinical situation, surgeon's experience, environment and operating room conditions. It is necessary to evaluate in terms of various variables such as. Keywords: Trochanteric fracture, PFNA, Locked blade, Unlocked blade