{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T03:53:29Z","timestamp":1783655609509,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,3,28]],"date-time":"2020-03-28T00:00:00Z","timestamp":1585353600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"KMC Mangalore"},{"name":"Manipal Academy of Higher Education"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Advances in Orthopedics"],"published-print":{"date-parts":[[2020,3,28]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>. Proximal femoral nail antirotation-2 (PFNA-2) has been widely used to treat intertrochanteric fractures with varied outcomes in the previous studies. The entry point of the nail plays an important role in achieving acceptable reduction, stable fixation, and avoiding implant related complications. This study was proposed to determine the optimal greater trochanteric entry point for PFNA-2 in unstable intertrochanteric femur fractures.<jats:italic>Methods<\/jats:italic>. We conducted an observational study on 40 patients with unstable intertrochanteric fracture treated with PFNA-2 implant in a tertiary care hospital. The patients were grouped into two based on the entry point: group L for lateral and group M for medial entry. Randomization was carried out by assigning the patients to the group by alternate allocation. The quality of reduction, tip apex distance, Cleveland index, and all the complications were noted. The final follow-up was conducted at six months. The functional outcome was evaluated using modified Harris hip score. The data analysis was performed using Student\u2019s<jats:italic>t<\/jats:italic>-test, chi square test, and Mann\u2013Whitney test. A<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mi>P<\/mml:mi><\/mml:math>value below 0.05 was considered significant.<jats:italic>Results<\/jats:italic>. Forty patients with 20 patients treated with medial entry point were included in group M and 20 patients in group L with lateral entry point. The group L had an average tip apex distance of 20.53 and group M had 20.02 (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mrow><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.8<\/mml:mn><\/mml:mrow><\/mml:math>). The complication of screw back out was seen in 3 out of 4 patients with poor reduction in group L. As per the Cleveland index, 6 patients in each group had suboptimal position and 4 out of 6 patients in group L with suboptimal position had screw back out. The lateral cortex impingement was seen in 14 patients of group L and 6 patients in group M with significant comparison (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mrow><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.01<\/mml:mn><\/mml:mrow><\/mml:math>). Three patients in group L had varus collapse with screw back out. Also, none in group M (0.05). The average modified Harris hip score in group L at six months follow-up was 71.94 and 76.8 in group M (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mrow><mml:mi>P<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.84<\/mml:mn><\/mml:mrow><\/mml:math>).<jats:italic>Conclusion<\/jats:italic>. Overall, to achieve good quality of fixation and reducing damage to gluteus medius entry point for PFNA-2 should be 5\u2009mm medial to the greater trochanter tip.<\/jats:p>","DOI":"10.1155\/2020\/2834816","type":"journal-article","created":{"date-parts":[[2020,3,28]],"date-time":"2020-03-28T23:30:36Z","timestamp":1585438236000},"page":"1-7","source":"Crossref","is-referenced-by-count":10,"title":["The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points"],"prefix":"10.1155","volume":"2020","author":[{"given":"Sharan","family":"Mallya","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5511-2323","authenticated-orcid":true,"given":"Surendra U.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendra","family":"Annappa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithin Elliot","family":"Nazareth","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Father Muller Medical College Hospital, Mangalore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krithika","family":"Kamath","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragya","family":"Tyagi","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5413.34497"},{"issue":"1","key":"2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.13107\/ti.2015.v01i01.004","volume":"1","year":"2015","journal-title":"Trauma 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