{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:25:13Z","timestamp":1789683913127,"version":"4.0.1"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cephalomedullary nailing systems, such as the trochanteric femoral nail advanced (TFNa), are standard of care for trochanteric fractures. The TFNa system allows for the use of either a helical blade or a lag screw for femoral neck fixation, but there is ongoing debate regarding which component provides superior outcomes. The aim of this study was to compare the performance of these two components in maintaining fracture reduction and preventing mechanical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A prospective cohort study enrolled 201 patients aged 50 years or older with type 31A1-31A2 (pertrochanteric) and 31A3 (intertrochanteric) fractures, as classified by the Arbeitsgemeinschaft f\u00fcr Osteosynthesefragen (AO)\/Orthopaedic Trauma Association (OTA), all treated with the short TFNa. Patients were allocated to helical blade (n = 101) or lag screw (n = 100) cohorts. Radiographic outcomes\u2014changes in the tip-apex distance (TAD), femoral neck shortening, and changes in the neck-shaft angle (NSA)\u2014were assessed at 3 months. Secondary outcomes included mechanical complications, patient-reported outcome measures (PROMs), and number of patients deceased at 1-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Radiographic outcomes among pertrochanteric fractures\u2014femoral neck shortening, NSA, and TAD changes\u2014were comparable between cohorts. Owing to limited power, no conclusions could be drawn for intertrochanteric fractures. Mechanical complication rates were similar between groups (blades: 4.0%, screws: 6.0%), with no significant association between femoral neck component and complications. A postoperative TAD greater than 20 mm was significantly associated with increased mechanical complications (odds ratio = 4.4, p = 0.023). PROMs improved similarly in both groups over time, and the number of patients deceased within 1 year after the operation was identical in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The findings indicate that helical blades and lag screws offer comparable stability in pertrochanteric fracture fixation within the TFNa system. Femoral neck component choice does not significantly affect mechanical complication rates or clinical outcomes. Rather, optimal implant placement and a postoperative TAD under 20 mm are key to successful outcomes. These results support prioritizing surgical precision over component selection in managing pertrochanteric fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\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.oa.25.00073","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T18:01:22Z","timestamp":1761156082000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Maintenance of Postoperative Reduction in Trochanteric Fracture Fixation"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7625-6465","authenticated-orcid":false,"given":"Matthias","family":"Wittauer","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Fremantle and Fiona Stanley Hospitals, Perth, Australia"},{"name":"The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia"},{"name":"Faculty of Medicine, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4256-2354","authenticated-orcid":false,"given":"Joseph","family":"Henry","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fremantle and Fiona Stanley Hospitals, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fremantle and Fiona Stanley Hospitals, Perth, Australia"},{"name":"The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia"},{"name":"Division of Surgery, University of Western Australia, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piers J.","family":"Yates","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fremantle and Fiona Stanley Hospitals, Perth, Australia"},{"name":"The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, Australia"},{"name":"Division of Surgery, University of Western Australia, Perth, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10]]},"reference":[{"issue":"7","key":"R1-20251022","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1093\/oxfordjournals.aje.a008800","article-title":"Heterogeneity of hip fracture: age, race, sex, and geographic patterns of femoral neck and trochanteric fractures among the US elderly","volume":"143","author":"Karagas","year":"1996","journal-title":"Am J Epidemiol."},{"issue":"14","key":"R2-20251022","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1001\/jama.2009.1462","article-title":"Incidence and mortality of hip fractures in the United States","volume":"302","author":"Brauer","year":"2009","journal-title":"JAMA"},{"key":"R3-20251022","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.bone.2014.06.011","article-title":"Mortality in British hip fracture patients, 2000-2010: a population-based retrospective cohort study","volume":"66","author":"Klop","year":"2014","journal-title":"Bone"},{"issue":"1","key":"R4-20251022","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1186\/s13018-021-02874-9","article-title":"All-cause mortality risk in aged femoral intertrochanteric fracture patients","volume":"16","author":"Li","year":"2021","journal-title":"J Orthop Surg Res."},{"issue":"2","key":"R5-20251022","doi-asserted-by":"crossref","first-page":"112146","DOI":"10.1016\/j.injury.2025.112146","article-title":"Optimising reduction and implant positioning in intertrochanteric fracture treatment: an evaluation of the effects of a structured educational program","volume":"56","author":"Wittauer","year":"2025","journal-title":"Injury"},{"issue":"9","key":"R6-20251022","doi-asserted-by":"crossref","first-page":"833","DOI":"10.2106\/JBJS.I.01403","article-title":"Increased use of intramedullary nails for intertrochanteric proximal femoral fractures in veterans affairs hospitals: a comparative effectiveness study","volume":"94","author":"Radcliff","year":"2012","journal-title":"J Bone Jt Surg."},{"issue":"1","key":"R7-20251022","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4055\/cios20204","article-title":"Are intertrochanteric fractures evolving? 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