ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
This article is part of the Research TopicInnovations and Advancements in Intramedullary Nailing for Lower Limb Fracture ManagementView all 4 articles
Horizontal Positioning for Accurate Lateral Helical Blade Insertion in Proximal Femoral Nail Antirotation (PFNA) for Elderly Osteoporotic Patients
Provisionally accepted
- Department of Orthopedic Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai Uninversity, Tianjin, China
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Objective: This study aimed to investigate the horizontal positioning (HP) technique for the precise lateral insertion of the helical blade guide pin during proximal femoral nail antirotation (PFNA) procedures for elderly osteoporotic patients. Methods: This retrospective study involved elderly osteoporotic patients with femoral intertrochanteric fractures treated at Tianjin Union Medical Center from January to December 2024. Patients were categorized into the HP group and the traditional true lateral view (TLV) group. The analyzed variables included fracture classification, horizontal anteversion angle (HAA), success rate of one-time lateral pin placement (SR-OLPP), pin insertion time, frequency of intraoperative lateral fluoroscopy images (FILFI), Parker’s ratio index, lag screw placement, tip-apex distance (TAD), and reduction quality. Results: A total of 86 patients participated in the study (HP group: n=46; TLV group: n=40), with no significant differences in baseline characteristics between the groups. The HP group demonstrated a significantly shorter pin insertion time compared to the TLV group (1 [1-3] min vs 3 [2–5] min, p<0.001) and required fewer intraoperative lateral fluoroscopy images (1 [1–3] vs 3 [2–6], p<0.001). The horizontal anteversion angle in the HP group was 6.4 ± 6.3°. The success rate of one-time lateral pin placement was higher in the HP group (95.7% vs 85.0%, p=0.138). No significant differences were found between two groups concerning reduction quality or spiral blade position and short-term postoperative complications. Conclusion: HP technology may enhance surgical efficiency and reduce radiation exposure while maintaining surgical safety and the accuracy of nail placement.
Keywords: Anteversion Angle, Elderly osteoporotic patients, Intertrochanteric fracture, Proximal femoral nail, Radiation exposure
Received: 01 Oct 2025; Accepted: 20 Jan 2026.
Copyright: © 2026 Wang, Dong, Yan and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yanqing Wang
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