Proximal femoral nail anti-rotation with and without cable cerclage for intertrochanteric femoral fractures with vulnerable lateral wall: a retrospective cohort study.

OBJECTIVES: The purpose of this study was to compare the surgical outcomes, perioperative and after-discharge structural and functional recovery of proximal femoral nail anti-rotation (PFNA) combined with and without cable cerclage for intertrochanteric femoral fractures with vulnerable lateral wall. METHODS: In this retrospective analysis, 80 patients of intertrochanteric femoral fractures with vulnerable lateral wall were divided into two groups according to internal fixation: 60 in the PFNA group (group P) and 20 in the PFNA combined with cable cerclage group (group PCC). Postoperative complications and functional outcomes were assessed. RESULTS: The mean follow-up was 23.34 ± 2.85 months in the P group versus 24.85 ± 3.42 ones in PCC group without statistical significance. The PCC group exhibited significantly longer surgical time, fluoroscopy time, shorter fracture union, partial weight-bearing time and less neck-shaft angle change than those in the P group (p value < 0.05). Harris Hip Score (HHS) at 3, 6 months was higher in the PCC group (p value < 0.001). However, no significant differences were observed between the two groups regarding blood loss, Visual Analogue Scale (VAS) score, tip-apex distance (TAD), HHS at 12, 18 months and full weight-bearing time (p value > 0.05). Furthermore, no significant differences were noted in postoperative complications. CONCLUSION: The PFNA with and without cable cerclage both demonstrated similar and satisfactory functional outcomes and relatively-low complication rates in patients with vulnerable lateral wall in intertrochanteric femoral fractures. The PCC group was superior in accelerating bone union, minimizing hip deformity and promoting early rehabilitation.