Unstable Intertrochanteric Femur Fracture Fixation with PFNA2: Does Not Require Lateral Wall Fixation? A Study of 278 Patients

Lateral wall fracture is considered to be one of the major contributors to failure when such fractures are routinely treated with a sliding hip screw. Later, several publications stressed that the intramedullary device (IM) is the implant of choice in such cases. Hence, PFNA2 has become the implant of choice for unstable IT fractures in the Asian population since the last decade. However, with this background, we have assessed our results over the last 5 years, where PFNA2 was the only implant used for all IT fractures, irrespective of comminution and stability. Methods: This was a retrospective analysis of 309 patients with stable and unstable fractures in 3rd and 4th cranial nerves between June 2008 and June 2022 who were fixed with PFNA2 only, without additional fixation of the lateral wall. Results: All fractures united at an average of 14 weeks, without significant differences between the two groups (with and without lateral wall fracture). There was no statistically significant difference between the two groups with respect to TAD < 20 mm (p = 0.24) or neck-shaft valgus angle at the time of fixation (p = 0.31). There was no significant difference between the union rate, fracture collapse rate (p = 0.41), change in neck shaft angle (p = 0.11) or change in TAD (p = 0.44) between the surgery group and the union group. Two patients who presented with implant failure (one performed elsewhere) were revised and fixed with our technique with a PFNA2 without any lateral augmentation, and both went on to unite well. Conclusion: For a well-aligned anteromedial cortex, coupled with a valgus reduction in the neck shaft angle, a helical blade in the center-center region and a TAD of ˂20 mm, fixation of the lateral wall has no role in preventing fracture collapse or in the healing of unstable IT femur fractures.