{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:13:36Z","timestamp":1793578416727,"version":"4.5.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intramedullary nailing remains the standard treatment for Association Osteosynthesis\/Orthopaedic Trauma Association (AO\/OTA) 31-A2.3 intertrochanteric fractures, however, there are still high failure rates when managing those with large displaced coronal fragments. This study presents a modified cable-plate augmentation technique for optimizing coronal fragment stabilization during proximal femoral nail antirotation (PFNA) fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a double-center retrospective cohort study of geriatric patients diagnosed with AO\/OTA type A2.3 intertrochanteric fractures combined with large displaced coronal fragments, who underwent either standard PFNA fixation or modified cable-plate augmentation combined with PFNA fixation between January 2023 and March 2025. These two cohorts were compared in terms of surgical parameters and complication profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      84 geriatric patients with type A2.3 intertrochanteric fractures with displaced large coronal fragments were analyzed. 40 patients received the conventional fixation protocol, and 44 received the augmented fixation protocol. The cohorts demonstrated comparable demographics in terms of age, comorbidity index and bone mineral density. The operative outcomes revealed prolonged surgical duration in the augmented fixation group (86.6\u2009\u00b1\u200916.9\u2005min vs. 69.7\u2009\u00b1\u200914.0\u2005min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009\n                      <jats:sans-serif>0.01<\/jats:sans-serif>\n                      ), with higher intraoperative blood loss (134.2\u2009\u00b1\u200931.6\u2005mL vs. 112.7\u2009\u00b1\u200943.1\u2005mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:sans-serif>0.011<\/jats:sans-serif>\n                      ). Rehabilitation metrics significantly favored augmented fixation, as indicated by a lower VAS postoperation (3.4\u2009\u00b1\u20092.1 vs. 4.5\u2009\u00b1\u20092.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:sans-serif>0.026<\/jats:sans-serif>\n                      ), earlier weight-bearing initiation (2.2\u2009\u00b1\u20090.8 days vs. 5.1\u2009\u00b1\u20091.2 days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009\n                      <jats:sans-serif>0.01<\/jats:sans-serif>\n                      ) and accelerated radiographic union (10.5\u2009\u00b1\u20091.3 weeks vs. 13.2\u2009\u00b1\u20091.7 weeks,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009\n                      <jats:sans-serif>0.01<\/jats:sans-serif>\n                      ). The conventional fixation group presented higher complication rates (20% vs. 4.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). At the 12-month follow-up, functional recovery was superior in the augmented cohort (HHS: 92.3\u2009\u00b1\u200912.3 vs. 84.7\u2009\u00b1\u200913.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u2009\n                      <jats:sans-serif>0.01<\/jats:sans-serif>\n                      ) despite equivalent pain scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Compared with conventional PFNA fixation, the cable-plate augmentation technique significantly enhances the fixation stability in type A2.3 intertrochanteric fractures with large coronal fragments, resulting in a reduction in complications, acceleration of fracture union, and improvement in functional outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1649442","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:43:03Z","timestamp":1778823783000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cable-Plate augmentation improves the therapeutic effect of intramedullary nailing for AO\/OTA type A2.3 intertrochanteric fractures with large coronal fragments: a double-center retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Guofeng","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhangxin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Renmin Hospital of Wuhan University","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Renmin Hospital of Wuhan University","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haimeng","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of 94895 Health Team","place":["Zhangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingteng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Renmin Hospital of Wuhan University","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolong","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taoyi","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weichun","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Renmin Hospital of Wuhan University","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The 909th Hospital, School of Medicine, Xiamen University","place":["Zhangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"105832","DOI":"10.1016\/j.archger.2025.105832","article-title":"Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: a systematic analysis of the global burden of disease study 2021","volume":"133","author":"Tian","year":"2025","journal-title":"Arch Gerontol Geriatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e32920","DOI":"10.1097\/MD.0000000000032920","article-title":"Comparison of clinical outcomes with proximal femoral nail anti-rotation versus dynamic hip screw for unstable intertrochanteric femoral fractures: a meta-analysis","volume":"102","author":"Zhang","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"470","DOI":"10.2106\/JBJS.F.00679","article-title":"Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation","volume":"89","author":"Palm","year":"2007","journal-title":"J Bone Joint Surg Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.7507\/1002-1892.202001071","article-title":"Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall","volume":"34","author":"Chen","year":"2020","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"key":"B5","doi-asserted-by":"publisher","first-page":"afad154","DOI":"10.1093\/ageing\/afad154","article-title":"Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis","volume":"52","author":"Sarkies","year":"2023","journal-title":"Age Ageing"},{"key":"B6","doi-asserted-by":"publisher","first-page":"919225","DOI":"10.3389\/fsurg.2022.919225","article-title":"A sophisticated fracture classification system of the proximal femur trochanteric region (AO\/OTA-31A) based on 3D-CT images","volume":"9","author":"Chang","year":"2022","journal-title":"Front Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.injury.2016.12.015","article-title":"Fracture morphology of AO\/OTA 31-A trochanteric fractures: a 3D CT study with an emphasis on coronal fragments","volume":"48","author":"Cho","year":"2017","journal-title":"Injury"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1604441","DOI":"10.3389\/fbioe.2025.1604441","article-title":"Cementless long-stem fixation in periprosthetic clamshell fracture: a biomechanical investigation","volume":"13","author":"Zhu","year":"2025","journal-title":"Front Bioeng Biotechnol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1097\/JCMA.0000000000000042","article-title":"Radiographic risk factors for predicting failure of geriatric intertrochanteric fracture treatment with a cephalomedullary nail","volume":"82","author":"Hsu","year":"2019","journal-title":"J Chin Med Assoc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"21514593231153827","DOI":"10.1177\/21514593231153827","article-title":"Two-Part intertrochanteric femur fractures with bisection of the lesser trochanter: an irreducible fracture pattern","volume":"14","author":"Hu","year":"2023","journal-title":"Geriatr Orthop Surg Rehabil"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2807","DOI":"10.1016\/j.arth.2024.04.085","article-title":"Effects of cerclage cabling on preventing periprosthetic femoral fractures when using cementless stems for unstable femoral neck fractures","volume":"39","author":"Iwasa","year":"2024","journal-title":"J Arthroplasty"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.7507\/1002-1892.202408068","article-title":"Characteristics of posterior coronal banana-shaped fragments and its research progress in treatment of intertrochanteric femoral fracture with cephalomedullary nail","volume":"38","author":"Li","year":"2024","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1007\/s43465-023-00964-w","article-title":"The impact of banana-shaped fragments on trochanteric hip fractures treated by PFNA","volume":"57","author":"Mao","year":"2023","journal-title":"Indian J Orthop"},{"key":"B14","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.injury.2020.01.019","article-title":"Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: a notable preoperative risk factor for implant failure","volume":"51","author":"Li","year":"2020","journal-title":"Injury"},{"key":"B15","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/j.arthro.2024.04.012","article-title":"The windshield wiper sign is an instability-related osteochondral defect of the anterolateral femoral head","volume":"41","author":"Girardi","year":"2025","journal-title":"Arthroscopy"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e36103","DOI":"10.7759\/cureus.36103","article-title":"Comparative study of different entry spots on postoperative gluteus Medius muscle cross-sectional area in patients with intertrochanteric fractures nailing","volume":"15","author":"Noda","year":"2023","journal-title":"Cureus"},{"key":"B17","doi-asserted-by":"publisher","first-page":"817","DOI":"10.2106\/JBJS.23.00830","article-title":"Comparing the biomechanical stability of cerclage cable with plate insert versus locking screw in periprosthetic humeral fracture","volume":"106","author":"Lee","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.2106\/JBJS.23.01152","article-title":"Integrated dual lag screws have higher reoperation rates for fixation failure than single lag component cephalomedullary nails: a retrospective study of 2,130 patients with intertrochanteric femoral fractures","volume":"106","author":"Gonzalez","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2365","DOI":"10.1007\/s00264-022-05488-w","article-title":"Does augmentation of intramedullary nails by a buttress plate effectively restore lateral wall integrity in intertrochanteric fractures","volume":"46","author":"Jain","year":"2022","journal-title":"Int Orthop"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1016\/j.injury.2020.06.008","article-title":"Modified candy-package technique vs cerclage technique for refixation of the lesser trochanteric fragment in pertrochanteric femoral fractures. A biomechanical comparison of 10 specimens","volume":"51","author":"Schopper","year":"2020","journal-title":"Injury"},{"key":"B21","doi-asserted-by":"publisher","first-page":"103003","DOI":"10.1016\/j.otsr.2021.103003","article-title":"Cerclage cable augmentation does not increase stability of the fixation of intertrochanteric fractures. A biomechanical study","volume":"107","author":"Ceynowa","year":"2021","journal-title":"Orthop Traumatol Surg Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1177\/0300060517710584","article-title":"INTERTAN Nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis","volume":"45","author":"Zhang","year":"2017","journal-title":"J Int Med Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1186\/s13018-023-04103-x","article-title":"Dual-screw versus single-screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis","volume":"18","author":"Yang","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"5340504","DOI":"10.1155\/2022\/5340504","article-title":"The clinical efficacy of minimally invasive clamp-assisted reduction and open reduction with wire cerclage for unstable subtrochanteric fractures","volume":"2022","author":"Liu","year":"2022","journal-title":"J Healthc Eng"},{"key":"B25","doi-asserted-by":"publisher","first-page":"190","DOI":"10.55095\/achot2011\/031","article-title":"Cerclage, evolution and potential of a Cinderella technology. An overview with reference to periprosthetic fractures","volume":"78","author":"Perren","year":"2011","journal-title":"Acta Chir Orthop Traumatol Cech"},{"key":"B26","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1089\/sur.2017.089","article-title":"Prolonged operative duration increases risk of surgical site infections: a systematic review","volume":"18","author":"Cheng","year":"2017","journal-title":"Surg Infect (Larchmt)"}],"updated-by":[{"DOI":"10.3389\/fsurg.2026.1882493","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000}}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1649442\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T08:08:00Z","timestamp":1781251680000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1649442\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":26,"alternative-id":["10.3389\/fsurg.2026.1649442"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1649442","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]},"article-number":"1649442"}}