{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T12:13:52Z","timestamp":1767183232242,"version":"3.43.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Subtrochanteric fractures have anatomic characteristics distinct from intertrochanteric fractures that may affect the positioning of the spiral blade during surgical treatment. Tip\u2010apex distance (<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content>) and calcar\u2010referenced tip\u2010apex distance (Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content>) were measured to determine if these measures are reliable indicators to assist in the accurate placement of intramedullary nails and minimize postoperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>For patients treated with proximal femoral nail antirotation (<jats:styled-content style=\"fixed-case\">PFNA<\/jats:styled-content>) internal fixation between 2016 and 2020, we analyzed the <jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content>, Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content>, and postoperative complications. Fracture healing was assessed radiographically at 6\u2010week intervals until union. The incidences of axial cut\u2010off, cephalad cut\u2010off, and non\u2010union were also examined. Analysis of variance and Fisher's exact test were performed to evaluate differences in complications between the <jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> and Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data from 104 patients (58 males, 46 females) with a mean age of 56.9\u2009years were analyzed. Fracture healing was observed in 90 (86.5%) patients at an average time of 14.92\u2009\u00b1\u20091.81\u2009weeks. The healing rate was significantly higher when the <jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> and Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> were controlled within the 20\u201325\u2009mm range (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Postoperative complications occurred in 14 (13.5%) cases [cephalad cut\u2010off, <jats:italic>n<\/jats:italic>\u2009=\u20095 (4.8%); axial cut\u2010off, <jats:italic>n<\/jats:italic>\u2009=\u20094 (3.8%); non\u2010union, <jats:italic>n<\/jats:italic>\u2009=\u20095 (4.8%)]. Five (4.8%) complications occurred without internal fixation failure. The fracture healing time and incidence of complications differed among groups defined by <jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> and Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> measurements, and were shortest and lowest, respectively, in the 20\u2009mm\u2009&lt;\u2009<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content>\/Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content>\u2009&lt;\u200925\u2009mm group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In our cohort, use of <jats:styled-content style=\"fixed-case\">PFNA<\/jats:styled-content> internal fixation for treatment of unstable femoral subtrochanteric fractures and placement of the spiral blade in the middle or lower 1\/3 of the femoral neck did not increase the incidence of complications. Therefore, we propose that the <jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> rule of 20\u201330\u2009mm should not apply to subtrochanteric fractures, and <jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> and Cal\u2010<jats:styled-content style=\"fixed-case\">TAD<\/jats:styled-content> should be controlled within the range of 20\u201325\u2009mm to reduce the incidence of complications.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.70051","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T06:07:39Z","timestamp":1750140459000},"page":"2291-2301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Appropriate Positioning of the Spiral Blade in Treatment of Subtrochanteric Fractures of the Femur Using Proximal Femoral Nail Antirotation"],"prefix":"10.1111","volume":"17","author":[{"given":"Qingyan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Lower Limbs Sichuan Orthopaedic Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaogang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Lower Limbs Sichuan Orthopaedic Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Longhui","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Lower Limbs Sichuan Orthopaedic Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4672-0431","authenticated-orcid":false,"given":"Qiang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Lower Limbs Sichuan Orthopaedic Hospital  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_13_2_1","DOI":"10.1097\/BOT.0000000000000689"},{"doi-asserted-by":"publisher","key":"e_1_2_13_3_1","DOI":"10.1002\/jbmr.4284"},{"doi-asserted-by":"publisher","key":"e_1_2_13_4_1","DOI":"10.1097\/BOT.0b013e31826fc03f"},{"doi-asserted-by":"publisher","key":"e_1_2_13_5_1","DOI":"10.1016\/j.injury.2012.09.013"},{"doi-asserted-by":"publisher","key":"e_1_2_13_6_1","DOI":"10.1016\/j.injury.2017.09.001"},{"doi-asserted-by":"publisher","key":"e_1_2_13_7_1","DOI":"10.1016\/j.otsr.2019.04.027"},{"key":"e_1_2_13_8_1","first-page":"4442","article-title":"Comparison of PFNA and DHS in the Treatment of Sarcopenia With Seinsheimer Type V Subtrochanteric Fracture","volume":"27","author":"Guan G. 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