Helical Blade Versus Lag Screw Fixation in the Cephalomedullary Nailing of Geriatric Hip Fractures

Background: While some prior research has shown helical blades to have higher risks of fixation failure and cut-out than lag screws in the cephalomedullary nailing of intertrochanteric femoral fractures, other studies have not demonstrated any such differences. The purpose of this study was to compare the performance of helical blade and lag screw fixation among older patients with a hip fracture treated with cephalomedullary nailing and to determine whether the relative performance of these 2 fixation methods varies on the basis of patient characteristics. Methods: This retrospective cohort study utilized the hip fracture registry of an integrated health-care system to identify patients ≥60 years old who underwent cephalomedullary nailing with a helical blade or lag screw from 2009 to 2023. Propensity score-weighted Cox proportional hazards regression was used to evaluate the risk of aseptic revision (the primary outcome measure) and the risks of revision for specific reasons (the secondary outcome measures), with mortality considered as a competing risk. Results: The study sample included 22,308 cases (11,877 with a helical blade and 10,431 with a lag screw; mean patient age, 81.7 years; 71.5% female; 73.3% White; 71.8% with an American Society of Anesthesiologists [ASA] classification of ≥3). The 10-year cumulative incidence of aseptic revision was 1.69% (n = 194) in the helical blade group and 1.88% (n = 182) in the lag screw group (adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.69 to 1.11; p = 0.27). There was evidence of effect modification by ASA classification, with the helical blade outperforming the lag screw in patients with an ASA of 1 to 2 (aseptic revision incidence, 1.74% versus 2.56%; adjusted HR, 0.65; 95% CI, 0.43 to 0.98; p = 0.04) but not in those with an ASA of ≥3 (aseptic revision incidence, 1.72% versus 1.64%; adjusted HR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85). There was no evidence of effect modification by age or sex. Conclusions: In this study of geriatric patients with a hip fracture treated with cephalomedullary nailing, helical blade and lag screw fixation performed similarly overall. Our finding that helical blade fixation may perform better in healthier (ASA 1 to 2) geriatric patients is interesting and deserves further investigation. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.