Clinical efficacy of proximal femoral nail anti-rotation in elderly patients with intertrochanteric fractures with negative medial cortical support: A comparison of lithotomy and scissor position techniques

Background Femoral intertrochanteric fractures are a prevalent type of hip fracture among the elderly population. And proximal femoral nail anti-rotation (PFNA) is the leading surgical technique for managing femoral intertrochanteric fractures in this patient population. Objective This study aimed to evaluate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) in managing intertrochanteric fractures in elderly patients with negative medial cortical support. Additionally, the outcomes associated with two different nail positioning techniques were investigated. Methods Elderly patients with femoral intertrochanteric fractures with negative medial cortical support, treated between January 2017 and January 2021, were included. A retrospective analysis of their clinical data was conducted. Patients were categorized into two groups based on the positioning technique: lithotomy position group (n = 40) and scissor position group (n = 40). Baseline characteristics, perioperative indicators, hidden blood loss, and Harris hip scores were compared. Results The groups exhibited no significant differences in baseline characteristics, incision length, or postoperative tip-apex distance. The scissor position group experienced fewer fluoroscopies, shorter surgical durations, and lower Visual Analogue Scale (VAS) scores for the unaffected limb on postoperative day 1 compared to the lithotomy position group. No significant differences in hidden blood loss were observed between the groups. The Harris hip score for the unaffected side showed no significant differences between the scissor position group on postoperative day 1 and postoperative month 1. However, in the lithotomy position group, the Harris hip score of the unaffected side on postoperative day 1 was significantly lower than that at postoperative month 1. Additionally, the Harris hip score for the unaffected side on postoperative day 1 was substantially higher in the scissor position group compared to the lithotomy position group, although there were no significant differences between the two groups at postoperative month 1. Conclusion PFNA in the scissor position demonstrated advantages over the lithotomy position, including reduced fluoroscopy usage, shorter surgical duration, and less trauma to the unaffected limb. These findings indicate its effectiveness in managing intertrochanteric fractures in elderly patients with negative medial cortical support.