Radiographic comparison of compression hip screws and cephalomedullary nails in stable femoral trochanteric fractures.

INTRODUCTION

This study aimed to radiographically compare cephalomedullary nails (CMN) and compression hip screws (CHS) in stable intertrochanteric femoral fractures, specifically assessing femoral offset (FO), neck-shaft angle (NSA), and leg length discrepancy (LLD).

MATERIALS AND

METHODS

This study retrospectively reviewed 181 patients treated between October 2020 and March 2024. After exclusions, 59 patients (CHS: 32; CMN: 27) with AO/OTA 31A1 fractures were included. Radiographic parameters (NSA, FO, and LLD) were measured using pre- and postoperative radiographs and preoperative CT. Rotational and magnification corrections were applied. Group comparisons were conducted using the Mann-Whitney U and Fisher's exact tests.

RESULTS

Postoperative and final NSA were significantly smaller (more varus) in the CMN group compared with the CHS group (postoperative NSA: 125.4° ± 8.0° vs. 133.0° ± 8.4°, p < 0.001). Measured FO was greater in the CMN group postoperatively and at final follow-up, but differences were not significant after correction. LLD was significantly greater in the CMN group (corrected postoperative LLD: CMN - 3.6 ± 3.5 mm vs. CHS 1.1 ± 2.5 mm, p < 0.001). Corrected NSA and FO did not differ significantly from those on the contralateral side in either group, and the proportion of patients with > 20% FO deviation was comparable. Bone union occurred in 58 of 59 cases; one CMN case required reoperation due to cut-through. Functional Ambulation Category scores showed no significant differences.

CONCLUSION

CHS tended toward valgus and CMN tended toward varus alignment; however, corrected NSA and FO were restored to near-contralateral values in both groups. Limb shortening was greater after CMN fixation, although it was likely not clinically significant. Both implants provided reliable fixation and similar functional outcomes. Larger studies assessing detailed gait parameters are warranted to clarify the clinical impact of these radiographic differences.