Cable-Plate augmentation improves the therapeutic effect of intramedullary nailing for AO/OTA type A2.3 intertrochanteric fractures with large coronal fragments: a double-center retrospective study.

BACKGROUND

Intramedullary nailing remains the standard treatment for Association Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) 31-A2.3 intertrochanteric fractures, however, there are still high failure rates when managing those with large displaced coronal fragments. This study presents a modified cable-plate augmentation technique for optimizing coronal fragment stabilization during proximal femoral nail antirotation (PFNA) fixation.

METHODS

We conducted a double-center retrospective cohort study of geriatric patients diagnosed with AO/OTA type A2.3 intertrochanteric fractures combined with large displaced coronal fragments, who underwent either standard PFNA fixation or modified cable-plate augmentation combined with PFNA fixation between January 2023 and March 2025. These two cohorts were compared in terms of surgical parameters and complication profiles.

RESULTS

84 geriatric patients with type A2.3 intertrochanteric fractures with displaced large coronal fragments were analyzed. 40 patients received the conventional fixation protocol, and 44 received the augmented fixation protocol. The cohorts demonstrated comparable demographics in terms of age, comorbidity index and bone mineral density. The operative outcomes revealed prolonged surgical duration in the augmented fixation group (86.6 ± 16.9 min vs. 69.7 ± 14.0 min, p < 0.01), with higher intraoperative blood loss (134.2 ± 31.6 mL vs. 112.7 ± 43.1 mL, p = 0.011). Rehabilitation metrics significantly favored augmented fixation, as indicated by a lower VAS postoperation (3.4 ± 2.1 vs. 4.5 ± 2.3, p = 0.026), earlier weight-bearing initiation (2.2 ± 0.8 days vs. 5.1 ± 1.2 days, p < 0.01) and accelerated radiographic union (10.5 ± 1.3 weeks vs. 13.2 ± 1.7 weeks,p < 0.01). The conventional fixation group presented higher complication rates (20% vs. 4.8%, p < 0.05). At the 12-month follow-up, functional recovery was superior in the augmented cohort (HHS: 92.3 ± 12.3 vs. 84.7 ± 13.8, p < 0.01) despite equivalent pain scores.

CONCLUSION

Compared with conventional PFNA fixation, the cable-plate augmentation technique significantly enhances the fixation stability in type A2.3 intertrochanteric fractures with large coronal fragments, resulting in a reduction in complications, acceleration of fracture union, and improvement in functional outcomes.