Distal locked and unlocked nailing for perthrochanteric fractures--a prospective comparative randomized study

Intramedullary nailing is widely used in the treatment of stable pertrochanteric fractures. However, it remains controversial whether the distal locking with intramedullary nailing is necessary.

In this study, 70 patients over the age of 65 with pertrochanteric fractures (AO/OTA 31-A1 and A2) were enrolled and randomly divided into two groups for treatment by intramedullary nails either with or without distal locking. Intra-operative variables such as operation time, volume of blood loss, total fluoroscopy time, total length of incision, postoperative complications and clinical outcomes were recorded and compared between the two groups.

A total of 29 patients in the locking group and 30 patients in the unlocking group completed one year of follow up. Operation time (39.2 ± 7.6 min), blood loss (158.6 ± 63.6 ml), fluoroscopy time (53.7 ± 3.9 s), and total length of incision (13.1 ± 2.1 cm) in the unlocking group were significantly decreased compared with the locking group (48.5 ± 9.0 min; 194.3 ± 61.6 ml; 57.8 ± 4.3 s; 10.9 ± 1.7 cm) (p < 0.05). No significant differences in postoperative complications and fracture union were identified between the two groups. Most patients in the locking group (80.0 %) and the unlocking group (77.1 %) recovered to their pre-injury activity levels.

This study suggests that intramedullary nails without distal locking may be a reliable and acceptable option for treating stable pertrochanteric fractures (AO/OTA 31-A1 and A2) in elderly people. Distal unlocked nails showed subtle advantages in reducing blood loss, operation time, fluoroscopy exposure time, and size of the incision.