Acta Chir Orthop Traumatol Cech. 2026; 93(2):94-102

Comparison of Clinical and Radiological Outcomes of Four Different Proximal Femoral Nailing Systems in the Treatment  of Intertrochanteric FracturesPůvodní práce

BEKIR KARAGOZ1, OZAN KECELI2, HÜNKAR CAGDAS BAYRAK3
1 Eskisehir City Hospital, Department of Orthopedics and Traumatology, Eskisehir, Turkey
2 Tarsus State Hospital, Department of Orthopedics and Traumatology, Mersin, Turkey
3 Cekirge State Hospital, Department of Orthopedics and Traumatology, Bursa, Turkey

Purpose of the study
This study aimed to compare the clinical and radiological outcomes of four different proximal femoral nailing systems—Proximal Femoral Nail Antirotation (PFNA), Dynamic Locked Trochanteric (DLT) nail, Intertan, and Talon Distalfix—used in the surgical treatment of intertrochanteric femoral fractures. The goal was to evaluate the differences between systems both statistically and in terms of clinical relevance.

Material and methods
A retrospective analysis was conducted on 309 patients who underwent PFN procedures between January 2015 and December 2019. Patients were categorized into four groups based on the type of nail used. Parameters assessed included operative time, intraoperative blood loss, fluoroscopy time, fracture union time, Harris Hip Score, WOMAC score, reduction quality, and complication rates. Additionally, Minimal Clinically Important Difference (MCID) values were calculated to assess the clinical significance of any observed differences.

Results
The Talon Distalfix group demonstrated significantly lower operative time, blood loss, and fluoroscopy duration (all p < 0.001). Since these differences exceeded MCID thresholds, they were considered not only statistically significant but also clinically meaningful. No significant differences were observed among the groups in terms of functional outcomes (Harris Hip Score, WOMAC score), fracture union time, or reduction quality. The overall complication rate was 22.9%, with screw cut-out being the most common complication (14.2%). Complication rates did not differ significantly between the groups.

Conclusions
The Talon Distalfix nail was found to offer both statistically and clinically significant advantages in terms of shorter operative time, reduced blood loss, and less fluoroscopy exposure. While functional outcomes and complication rates were similar across all groups, the findings suggest that implant design may play a decisive role in intraoperative parameters.

Klíčová slova: Key words: Intertrochanteric fracture, PFNA, DLT, Intertan, Talon Distalfix, MCID, proximal femoral nail.

Vloženo: 3. září 2025; Revidováno: 3. září 2025; Přijato: 10. únor 2026; Zveřejněno: 1. květen 2026  Zobrazit citaci

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
KARAGOZ B, KECELI O, BAYRAK HC. Comparison of Clinical and Radiological Outcomes of Four Different Proximal Femoral Nailing Systems in the Treatment  of Intertrochanteric Fractures. Acta Chir Orthop Traumatol Cech. 2026;93(2):94-102.
Sdílet...
Stáhnout citaci
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Zobrazit celý článek

    Reference

    1. Arican G, Subaşi Ö, Özmeriç A, İltar S, Alemdaroğlu KB, Dinçel VE. Talon Proksimal Femoral Çivileme(Pfn) Proksimal Femoral Çivi-Antirotasyon (Pfna) Kadar Başarili Mi? Acta Medica Alanya. 2019;3:261-266.
    2. Aycan M.F. Comparison of biomechanical properties of implant systems used in treatment of proximal femur fractures. Journal of the faculty of engineering and architecture of gazi university. 2019;34: 812-818.
    3. Buckley RE, Moran CG, Apivatthakakul T. AO Principles of fracture management. 3rd edition. Ed Thieme, 2017.
    4. Catania P, Passaretti D, Montemurro G, Ripanti S, Carbone S, Candela V, Carnovale M, Gumina S, Pallotta F. Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices. J Orthop Surg Res. 2019;14:449.
    5. Cipollaro L, Aicale R, Maccauro G, Maffulli N. Single-versus double-integrated screws in intramedullary nailing systems for surgical management of extracapsular hip fractures in the elderly: a systematic review. J Biol Regul Homeost Agents. 2019;33:175-182.
    6. Dettoni F, Pellegrino P, La Russa MR, Bonasia DE, Blonna D, Bruzzone M, Castoldi F, Rossi R.Validation and cross-cultural adaptation of the Italian version of the Harris Hip Score. Hip International.2015;25:91-97.
    7. Dhamangaonkar AC. Management options and treatment algorithm in intertrochanteric fractures. Trauma Int. 2015;1:12-16.
    8. Ertürer RE, Sönmez MM, Sari S, Seçkin MF, Kara A, Oztürk I. Intramedullary osteosynthesis of instable intertrochanteric femur fractures with Profin® nail in elderly patients. Acta Orthop Traumatol Turc. 2012;46:107-112.
    9. Jung EY, Oh IT, Shim SY, Yoon BH, Sung YB. The Effect of valgus reduction on the position of the blade of the proximal femoral nail antirotation in intertrochanteric hip fractures. Clin Orthop Surg. 2019;11:36-42.
    10. Konya MN, Korkusuz F, Maralcan G, Demir T, Aslan A. The use of a proximal femoralnail as a hip prosthesis: a biomechanical analysis of a newly designed implant. Proc Inst Mech Eng H. 2018;232:200-206.
    11. Kürüm H, Tosun HB, Aydemir F, Ayas O, Orhan K, Key S. Intertrochanteric femoral fractures: a comparative analysis of clinical and radiographic outcomes between talon intramedullary nail and intertan nail. Cureus. 2023;15:e50877.
    12. Kwak DK, Kim WH, Lee SJ, Rhyu SH, Jang CY, Yoo JH. Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur: experimental studies. Biomed Res Int. 2018:1-9.
    13. Lil NA, Makwana VR, Patel TD, Patel AR. Comparative study of intertrochanteric fracture fixation using proximal femoral nail with and without distal interlocking screws. World J Orthop. 2022;13:267-277.
    14. Mallya S, Kamath SU, Madegowda A, Krishnamurthy SL, Jain MK, Holla R. Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis. Eur J Orthop Surg Traumatol. 2019;29:1035-1042.
    15. Mao W, Ni H, Li L, He Y, Chen X, Tang H, Dong Y. Comparison of Baumgaertner and Chang reduction quality criteria for the assessment of trochanteric fractures. Bone Joint Res. 2019;8:502-508.
    16. Özmen E, Yağci TF, Yildirim AM, Altan M, Erşen A, Sağlam Y. Risk factors for early implant failure in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN). Risk factors for early implant failure in geriatric intertrochanteric fractures treated with a short loc-ked intramedullary nail with a double compression and derotation neck screw (InterTAN). Acta Chir Orthop Traumatol Cech. 2024;91:289-295.
    17. Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61:102-109.
    18. Sharma A, Mahajan A, John B. A comparison of the clinico-radiological outcomes with proximal femoral nail (PFN) and proximal femoral nail antirotation (PFNA) in fixation of unstable intertrochanteric fractures. J Clin Diagn Res. 2017;11:RC05-RC09.
    19. Shin WC, Seo JD, Lee SM, Moon NH, Lee JS, Suh KT. Radiographic outcomes of osteosynthesis using proximal femoral nail antirotation (PFNA) system in intertrochanteric femoral fracture: has PFNA II solved all the problems? Hip Pelvis. 2017;29:104-112.
    20. Temiz A, Durak A, Atici T. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail. Injury. 2015 ;46:41-46.
    21. Turgut A, Kalenderer O, Karapinar L, Kumbaraci M, Akkan HA, Aguş H. Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients. Arch Orthop Trau. 2016;136:623-630.
    22. Yalin M, Golgelioglu F, Key S. Intertrochanteric femoral fractures: a comparison of clinical and radiographic results with the proximal femoral intramedullary nail (PROFIN), the anti-rotation proximal femoral nail (A-PFN), and the InterTAN Nail. Medicina (Kaunas). 2023;59:559.
    23. Yapici F, Ucpunar H, Camurcu Y, Emirhan N, Tanoglu O, Tardus I. Clinical and radiological outcomes of patients treated with the talon distalfix proximal femoral nail for intertrochanteric femur fractures. Injury. 2020;51:1045-1050.
    24. Yapici F, Üçpunar H, Gür V, Onaç O, Alpay Y, Karaköse R, Çamurcu Y. Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly. Functional and radiological comparison of three cephalomedullary nails with different designs used in the tre-atment of unstable intertrochanteric femur fractures of elderly. Ulus Travma Acil Cerrahi Derg. 2022;28:668-677.
    25. Zehir S, Şahin E, Zehir R. Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures. Ulus Travma Acil Cerrahi Derg. 2015;21:469-476.
    26. Zeng C, Wang YR, Wei J, Gao SG, Zhang FJ, Sun ZQ, Lei GH. Treatment of trochanteric fractures with proximal femoral nail antirotation or dynamic hip screw systems: a meta-analysis. J Int Med Res. 2012;40:839-851.
    27. Zhang K, Zhang S, Yang J, Dong W, Wang S, Cheng Y, Al-Qwbani M, Wang Q, Yu B. Proximal femoral nail vs. dynamic hip screw in treatment of intertrochanteric fractures: a meta-analysis. Med Sci Monit. 2014;20:1628-1633.
    28. Zhang S, Zhang K, Jia Y, Yu B, Feng W. InterTan nail versus proximal femoral nail antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013;36: 288-294.

    Zpět na obsah