European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
Impact of limited intramedullary reaming versus unreamed technique in short proximal femoral nail anti-rotation for intertrochanteric fractures: a matched retrospective study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Ratanasermsub Napol, Amarase Chavarin, Jongsukkijpanich Peerapat, Osothcharoenphol Thanaphum, Innarkgool Sirasit, Viriyakorkitkul Supacheep, Tantavisut Saran
Аннотация
PURPOSE: Short proximal femoral nail antirotation (PFNA) fixation is commonly performed for intertrochanteric fractures and is typically inserted without reaming. However, limited reaming may be required in cases of a narrow femoral canal, severe femoral bowing, or inadvertent selection of an oversized nail. Unlike long nails, reaming for short PFNA is confined to the isthmus, and its effects have not been well described. This study aimed to evaluate the association between limited reaming during short PFNA fixation and clinical outcomes.
METHODS: We conducted a retrospective matched cohort study of patients aged ≥ 65 years who underwent short PFNA fixation for intertrochanteric fractures at a university-affiliated tertiary care center between January 2020 and August 2025. Patients were matched in a 1:3 ratio (limited reamed vs. unreamed) by age, sex, body mass index, ASA classification, and OTA/AO fracture type. Operative variables, perioperative hematologic parameters, transfusion requirements, length of hospital stay (LOS), radiographic fracture healing time, mortality, and postoperative complications were compared.
RESULTS: A total of 30 limited reamed and 90 unreamed patients were analyzed, with comparable baseline characteristics. The limited reamed group had a longer operative time (98.2 ± 27.9 vs. 80.0 ± 23.7 min; P = 0.001) and greater intraoperative blood loss (232.3 ± 143.5 vs. 169.2 ± 102.2 mL; P = 0.03). There were no differences in nail diameter, hematocrit decline, total transfusion volume, LOS, fracture healing time, mortality rate, or complications rate between the two groups (all P > 0.05). Follow-up beyond 3 months was 86.7%, and mean follow-up duration was comparable between groups.
CONCLUSIONS: The unreamed technique should be considered the preferred approach in most cases of short proximal femoral nail antirotation fixation. Limited canal reaming was associated with longer operative time and greater intraoperative blood loss. Therefore, limited reaming should be reserved for situations in which it is necessary to facilitate safe nail insertion, such as in patients with challenging canal anatomy or when an oversized nail is inadvertently selected.
LEVEL OF EVIDENCE: Therapeutic Level III.
METHODS: We conducted a retrospective matched cohort study of patients aged ≥ 65 years who underwent short PFNA fixation for intertrochanteric fractures at a university-affiliated tertiary care center between January 2020 and August 2025. Patients were matched in a 1:3 ratio (limited reamed vs. unreamed) by age, sex, body mass index, ASA classification, and OTA/AO fracture type. Operative variables, perioperative hematologic parameters, transfusion requirements, length of hospital stay (LOS), radiographic fracture healing time, mortality, and postoperative complications were compared.
RESULTS: A total of 30 limited reamed and 90 unreamed patients were analyzed, with comparable baseline characteristics. The limited reamed group had a longer operative time (98.2 ± 27.9 vs. 80.0 ± 23.7 min; P = 0.001) and greater intraoperative blood loss (232.3 ± 143.5 vs. 169.2 ± 102.2 mL; P = 0.03). There were no differences in nail diameter, hematocrit decline, total transfusion volume, LOS, fracture healing time, mortality rate, or complications rate between the two groups (all P > 0.05). Follow-up beyond 3 months was 86.7%, and mean follow-up duration was comparable between groups.
CONCLUSIONS: The unreamed technique should be considered the preferred approach in most cases of short proximal femoral nail antirotation fixation. Limited canal reaming was associated with longer operative time and greater intraoperative blood loss. Therefore, limited reaming should be reserved for situations in which it is necessary to facilitate safe nail insertion, such as in patients with challenging canal anatomy or when an oversized nail is inadvertently selected.
LEVEL OF EVIDENCE: Therapeutic Level III.