{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T10:08:55Z","timestamp":1793095735122,"version":"4.5.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>While some prior research has shown helical blades to have higher risks of fixation failure and cut-out than lag screws in the cephalomedullary nailing of intertrochanteric femoral fractures, other studies have not demonstrated any such differences. The purpose of this study was to compare the performance of helical blade and lag screw fixation among older patients with a hip fracture treated with cephalomedullary nailing and to determine whether the relative performance of these 2 fixation methods varies on the basis of patient characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective cohort study utilized the hip fracture registry of an integrated health-care system to identify patients \u226560 years old who underwent cephalomedullary nailing with a helical blade or lag screw from 2009 to 2023. Propensity score-weighted Cox proportional hazards regression was used to evaluate the risk of aseptic revision (the primary outcome measure) and the risks of revision for specific reasons (the secondary outcome measures), with mortality considered as a competing risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study sample included 22,308 cases (11,877 with a helical blade and 10,431 with a lag screw; mean patient age, 81.7 years; 71.5% female; 73.3% White; 71.8% with an American Society of Anesthesiologists [ASA] classification of \u22653). The 10-year cumulative incidence of aseptic revision was 1.69% (n = 194) in the helical blade group and 1.88% (n = 182) in the lag screw group (adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.69 to 1.11; p = 0.27). There was evidence of effect modification by ASA classification, with the helical blade outperforming the lag screw in patients with an ASA of 1 to 2 (aseptic revision incidence, 1.74% versus 2.56%; adjusted HR, 0.65; 95% CI, 0.43 to 0.98; p = 0.04) but not in those with an ASA of \u22653 (aseptic revision incidence, 1.72% versus 1.64%; adjusted HR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85). There was no evidence of effect modification by age or sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this study of geriatric patients with a hip fracture treated with cephalomedullary nailing, helical blade and lag screw fixation performed similarly overall. Our finding that helical blade fixation may perform better in healthier (ASA 1 to 2) geriatric patients is interesting and deserves further investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.00294","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T19:01:04Z","timestamp":1762196464000},"page":"2654-2660","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Helical Blade Versus Lag Screw Fixation in the Cephalomedullary Nailing of Geriatric Hip Fractures"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9310-9969","authenticated-orcid":false,"given":"Kanu","family":"Okike","sequence":"first","affiliation":[{"name":"Hawaii Permanente Medical Group, Honolulu, Hawaii"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2877-8562","authenticated-orcid":false,"given":"Richard N.","family":"Chang","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-5815","authenticated-orcid":false,"given":"Andrew S.","family":"Fang","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6429-242X","authenticated-orcid":false,"given":"Cameron","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald A.","family":"Navarro","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3116-6654","authenticated-orcid":false,"given":"Bobby","family":"Dezfuli","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6828-1449","authenticated-orcid":false,"given":"Kathryn E.","family":"Royse","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0991-4317","authenticated-orcid":false,"given":"Brian H.","family":"Fasig","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-8186","authenticated-orcid":false,"given":"Elizabeth W.","family":"Paxton","sequence":"additional","affiliation":[{"name":"Surgical Outcomes and Analysis Department, Kaiser Permanente, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"issue":"1","key":"bib1-20251203","doi-asserted-by":"crossref","first-page":"e0045","DOI":"10.2106\/JBJS.OA.18.00045","article-title":"Incidence and Economic Burden of Intertrochanteric Fracture: A Medicare Claims Database Analysis","volume":"4","author":"Adeyemi","year":"2019","journal-title":"JB JS Open Access."},{"issue":"4","key":"bib2-20251203","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2106\/JBJS.G.00517","article-title":"Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database","volume":"90","author":"Anglen","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib3-20251203","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/BOT.0000000000001193","article-title":"Helical Blade Versus Screw Fixation in the Treatment of Hip Fractures With Cephalomedullary Devices: Incidence of Failure and Atypical \u201cMedial Cutout\u201d","volume":"32","author":"Chapman","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib4-20251203","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/BOT.0000000000002045","article-title":"Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis","volume":"35","author":"Kim","year":"2021","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib5-20251203","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/BOT.0000000000000853","article-title":"Radiographic Review of Helical Blade Versus Lag Screw Fixation for Cephalomedullary Nailing of Low-Energy Peritrochanteric Femur Fractures: There is a Difference in Cutout","volume":"31","author":"Stern","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"7","key":"bib6-20251203","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1007\/s43465-023-00892-9","article-title":"Intramedullary Femur Nailing in Intertrochanteric Fractures: Postoperatively Do Helical Blades Migrate More Than Lag Screws? A Randomized Controlled Trial","volume":"57","author":"Upadhayay","year":"2023","journal-title":"Indian J Orthop."},{"issue":"3","key":"bib7-20251203","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1055\/a-1291-8619","article-title":"Clinical and Radiological Outcomes of Trochanteric AO\/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw - A Retrospective Cohort Study","volume":"160","author":"Hanc\u0131o\u011flu","year":"2022","journal-title":"Z Orthop Unfall."},{"issue":"3","key":"bib8-20251203","doi-asserted-by":"crossref","first-page":"695","DOI":"10.52312\/jdrs.2022.789","article-title":"Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials","volume":"33","author":"Huang","year":"2022","journal-title":"Jt Dis Relat Surg."},{"issue":"4","key":"bib9-20251203","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.injury.2019.02.015","article-title":"Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures: Are helical blades to blame?","volume":"50","author":"Ibrahim","year":"2019","journal-title":"Injury."},{"issue":"8","key":"bib10-20251203","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1007\/s00590-021-03124-8","article-title":"No difference between lag screw and helical blade for cephalomedullary nail cut-out a systematic review and meta-analysis","volume":"32","author":"Ng","year":"2022","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"7","key":"bib11-20251203","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s00590-021-02875-8","article-title":"Cephalomedullary helical blade is independently associated with less collapse in intertrochanteric femur fractures than lag screws","volume":"31","author":"Goodnough","year":"2021","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"6","key":"bib12-20251203","first-page":"1062","article-title":"Comparison of tip apex distance and cut-out complications between helical blades and lag screws in intertrochanteric fractures among the elderly: a meta-analysis","volume":"20","author":"Li","year":"2015","journal-title":"J Orthop Sci."},{"issue":"8","key":"bib13-20251203","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/BOT.0000000000002829","article-title":"Increased 1-Year Revision Rates Among Left-Sided Intertrochanteric Femur Fractures","volume":"38","author":"Gu","year":"2024","journal-title":"J Orthop Trauma."},{"issue":"18","key":"bib15-20251203","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.2106\/JBJS.16.01133","article-title":"Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Hip Fracture","volume":"99","author":"Okike","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib16-20251203","doi-asserted-by":"crossref","first-page":"174","DOI":"10.2106\/JBJS.24.00390","article-title":"Association Between Nail Type and Aseptic Revision Risk After Cephalomedullary Nailing for Hip Fracture","volume":"107","author":"Okike","year":"2025","journal-title":"J Bone Joint Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.00294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:53:59Z","timestamp":1787752439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.00294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":15,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.00294","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,3]]}}}