# Horizontal positioning for accurate lateral helical blade insertion in proximal femoral nail antirotation (PFNA) for elderly osteoporotic patients

## TL;DR

This study compares a new horizontal positioning technique with the traditional method for inserting a helical blade in hip surgery for elderly patients with osteoporosis.

## Contribution

The study introduces a horizontal positioning technique to improve the accuracy and efficiency of lateral helical blade insertion during PFNA procedures.

## Key findings

- The HP group had significantly shorter pin insertion times compared to the traditional method.
- The HP group required fewer intraoperative lateral fluoroscopy images.
- The HP technique showed a higher success rate for one-time lateral pin placement.

## Abstract

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.

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.

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) 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 post-operative complications.

HP technology may enhance surgical efficiency and reduce radiation exposure while maintaining surgical safety and the accuracy of nail placement.