# APBA Kısa Özet
A retrospective comparative observational study of 107 elderly patients with intertrochanteric femur fractures found no significant difference in overall complication rates between two antirotational implant types (A-PFN and Interclaw PFN). Mean tip-apex distance was similar between groups (23.6 vs 25.7 mm), with a ROC-determined cutoff of 31.3 mm. While both implants provided effective fixation, the Interclaw group showed a significantly higher Harris Hip Score (85.5 vs 77.5, P<0.001). Nine patients required revision surgery: 2 nail breakages, 6 cutouts, and 1 periprosthetic fracture. Proper screw placement and anatomical reduction were emphasized as key factors in minimizing cutout risk regardless of implant design.
# Çalışma neyi araştırdı?
This study compared the impact of two antirotational implants on cutout risk and mid-term clinical outcomes in elderly patients with intertrochanteric femur fractures. Overall, 107 patients (mean age, 80.10 years) who underwent intramedullary nailing for intertrochanteric femoral fractures between April 2018 and December 2020 were included in this study. Patients were divided into 2 groups: those treated with Antirotator Proximal Femoral Nail (A-PFN; group A) and those treated with Interclaw Proximal Femoral Nail Antirotation (group I). This study evaluated lag screw positioning using the Bosworth-Cleveland scale, reduction quality based on Baumgartner's criteria, tip-apex distance (TAD) values, cutoff values for TAD determined by receiver operating characteristic analysis, time from trauma to surgery, complications, and Harris Hip Score at the final follow-up.
# Yöntem
A retrospective comparative observational study was conducted involving 107 elderly patients with intertrochanteric femur fractures who underwent intramedullary nailing between April 2018 and December 2020. Patients were allocated into two groups based on the antirotational implant used: group A received the Antirotator Proximal Femoral Nail (A-PFN), while group I received the Interclaw Proximal Femoral Nail Antirotation. The study assessed various parameters including lag screw positioning according to the Bosworth-Cleveland scale, reduction quality based on Baumgartner's criteria, tip-apex distance (TAD) values, and cutoff values for TAD determined by receiver operating characteristic (ROC) analysis. Additional data collected included time from trauma to surgery, postoperative complications, and Harris Hip Score (HHS) at the final follow-up. Mean follow-up durations were 18.4 ± 8.8 months for group A and 16.15 ± 4.72 months for group I. Operative times were 89.38 ± 30.45 minutes for group A and 71.15 ± 27.87 minutes for group I.
# Temel bulgular
The study included 107 patients with a mean age of 80.10 years. The mean follow-up durations were 18.4 ± 8.8 months for group A and 16.15 ± 4.72 months for group I. Operative times were 89.38 ± 30.45 minutes for group A and 71.15 ± 27.87 minutes for group I. Mean tip-apex distance was 23.6 ± 1.14 mm for group A and 25.7 ± 1.19 mm for group I, with no significant difference between groups (P = .432). A ROC-determined cutoff value for TAD was 31.3 mm. While both implants provided effective fixation, the Interclaw group demonstrated a significantly higher Harris Hip Score (85.5) compared to the A-PFN group (77.5, P<0.001). Nine patients required revision surgery: 2 nail breakages, 6 cutouts, and 1 periprosthetic fracture.
# Bulgular ne anlama geliyor?
The findings suggest that while both antirotational implants (A-PFN and Interclaw PFN) provide effective fixation for intertrochanteric fractures in elderly patients, there is no significant difference in overall complication rates between the two designs. The similar mean tip-apex distances indicate that screw placement accuracy is comparable. However, the Interclaw implant was associated with better functional outcomes as measured by higher Harris Hip Scores. Proper screw placement and anatomical reduction were emphasized as key factors in minimizing cutout risk regardless of implant design. The similar complication rates and functional outcomes suggest that surgeon familiarity and patient-specific factors may influence implant selection more than inherent design differences.
# Klinik önem
Clinically, these results suggest that both A-PFN and Interclaw PFN are viable options for antirotational fixation in elderly patients with intertrochanteric fractures. The choice between implants may be guided by surgeon experience, specific patient anatomy, and desired functional outcomes, with the Interclaw group showing a trend toward higher Harris Hip Scores. Surgeons should prioritize proper screw placement and anatomical reduction to minimize cutout risk, as these factors were highlighted as more critical than implant design alone. The similar complication profiles support the use of either implant based on institutional preference or surgeon comfort level.
# Sınırlılıklar
This study has several limitations that should be considered when interpreting the results. The retrospective design limits causal inference, and the small sample size from a single center may not be representative of broader populations. No randomization or blinding was implemented, and there is potential for unmeasured confounders. Additionally, the mid-term follow-up only; long-term outcomes such as implant survival and revision rates beyond the follow-up period remain unknown. These factors warrant cautious interpretation of the findings and highlight the need for larger, prospective studies to confirm these observations.