{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T20:24:53Z","timestamp":1788812693347,"version":"build-2803163510"},"reference-count":28,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T00:00:00Z","timestamp":1726704000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n               <jats:title>Objective<\/jats:title>\n               <jats:p>Cephalomedullary nails (CMN) are implants with a high success rate in the surgical treatment of trochanteric fractures. The aim of this study is to compare the radiological outcomes and mechanical complications of femoral trochanteric fractures treated with three different CMNs.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Methods<\/jats:title>\n               <jats:p>Intertrochanteric fractures in patients aged 50 years and older treated with CMN between January 2016 and December 2021 were reviewed retrospectively. A total of 158 cases meeting the criteria were included to final analysis. Cases were divided into three groups based on the type of nail used (helical blade: group 1, <jats:italic>n<\/jats:italic>\u00a0=\u00a054; screw: group 2, <jats:italic>n<\/jats:italic>\u00a0=\u00a053; winged screw: group 3, <jats:italic>n<\/jats:italic>\u00a0=\u00a051). Demographic characteristics, mechanical complications, reduction quality, tip-apex distances (TAD) and Cleveland zones were compared between the groups. Femoral neck shortening, varus collapse, lag sliding, changes in abductor length were compared between study groups. Factors affecting mechanical complications were also analyzed.<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Results<\/jats:title>\n               <jats:p>Study groups were homogenic in terms of demographic characteristics, fracture type and reduction quality. Regarding mechanical complications, no statistically significant difference was found between groups. All three implants had similar outcomes on femoral neck shortening, varus collapse and lag sliding. Pooled analysis of 158 cases showed that mechanical complications increase as the quality of reduction decreases (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.000) same applies when TAD alters from the desired range (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.025) and with non-optimally implanted blade according to Cleveland zones (<jats:italic>p<\/jats:italic>\u00a0=\u00a00,\u00a0000).<\/jats:p>\n            <\/jats:sec>\n            <jats:sec>\n               <jats:title>Conclusion<\/jats:title>\n               <jats:p>The radiological outcomes and mechanical complications of helical blade, screw type blade and winged screw type blade proximal femoral nails are similar in selected group. Regardless of the device type, it is necessary to obtain high reduction quality, obtain TAD within described range and optimally place the blade according to Cleveland Zones to reduce the failure rate and avoid complications.<\/jats:p>\n            <\/jats:sec>","DOI":"10.7717\/peerj.18020","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T07:18:33Z","timestamp":1726730313000},"page":"e18020","source":"Crossref","is-referenced-by-count":3,"title":["Comparative analysis of radiological outcomes among cephalomedullary nails: helical, screw and winged screw"],"prefix":"10.7717","volume":"12","author":[{"given":"Arman","family":"Vahabi","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Engin","family":"Dastan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bunyamin","family":"Kilicli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Aljasim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huseyin","family":"Gunay","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadir","family":"Ozkayin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemal","family":"Aktuglu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Ege University, Izmir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"key":"10.7717\/peerj.18020\/ref-1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.5371\/HP.2021.33.2.71","article-title":"Outcomes of wedge wing in the lag screw for unstable intertrochanteric fractures in elderly patients","volume":"33","author":"Baik","year":"2021","journal-title":"Hip & Pelvis"},{"key":"10.7717\/peerj.18020\/ref-2","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.2106\/00004623-199507000-00012","article-title":"The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip","volume":"77","author":"Baumgaertner","year":"1995","journal-title":"The Journal of Bone and Joint Surgery"},{"issue":"Suppl 4","key":"10.7717\/peerj.18020\/ref-3","doi-asserted-by":"publisher","first-page":"S88","DOI":"10.1016\/S0020-1383(15)30024-3","article-title":"Femoral offset following trochanteric femoral fractures: a prospective observational study","volume":"46","author":"Buecking","year":"2015","journal-title":"Injury"},{"key":"10.7717\/peerj.18020\/ref-4","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/S00402-015-2206-X","article-title":"Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures","volume":"135","author":"Chang","year":"2015","journal-title":"Archives of Orthopaedic and Trauma Surgery"},{"issue":"1","key":"10.7717\/peerj.18020\/ref-5","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/S13018-019-1468-3","article-title":"Finite element analysis of two cephalomedullary nails in treatment of elderly reverse obliquity intertrochanteric fractures: zimmer natural nail and proximal femoral nail antirotation-II","volume":"15","author":"Chen","year":"2020","journal-title":"Journal of Orthopaedic Surgery and Research"},{"key":"10.7717\/peerj.18020\/ref-6","doi-asserted-by":"publisher","first-page":"110148","DOI":"10.1016\/J.JBIOMECH.2020.110148","article-title":"Improvement of clinical fracture healing - What can be learned from mechano-biological research?","volume":"115","author":"Claes","year":"2021","journal-title":"Journal of Biomechanics"},{"key":"10.7717\/peerj.18020\/ref-7","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1007\/S00402-016-2527-4","article-title":"Total hip replacement: increasing femoral offset improves functional outcome","volume":"136","author":"Clement","year":"2016","journal-title":"Archives of Orthopaedic and Trauma Surgery"},{"key":"10.7717\/peerj.18020\/ref-8","first-page":"1399","article-title":"A ten-year analysis of intertrochanteric fractures of the femur","volume":"41-A","author":"Cleveland","year":"1959","journal-title":"The Journal of Bone & Joint Surgery"},{"key":"10.7717\/peerj.18020\/ref-9","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/PL00004148","article-title":"World-wide projections for hip fracture","volume":"7","author":"Gullberg","year":"1997","journal-title":"Osteoporosis International: A Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA"},{"key":"10.7717\/peerj.18020\/ref-10","first-page":"26","article-title":"Does the wedge wing in the neck screw prevent cut-out failure in Ota\/AO 31-A2 trochanteric fractures in elderly patients?","volume":"80","author":"Gunay","year":"2014","journal-title":"Acta Orthopaedica Belgica"},{"key":"10.7717\/peerj.18020\/ref-11","doi-asserted-by":"publisher","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":"Journal of Orthopaedic Trauma"},{"key":"10.7717\/peerj.18020\/ref-12","doi-asserted-by":"publisher","first-page":"211","DOI":"10.5371\/HP.2013.25.3.211","article-title":"Comparison of the dyna locking trochanteric nail, proximal femoral nail antirotation and gamma 3 nail in treatment of intertrochanteric fracture of the femur","volume":"25","author":"Kim","year":"2013","journal-title":"Hip & Pelvis"},{"key":"10.7717\/peerj.18020\/ref-13","doi-asserted-by":"publisher","first-page":"7618079","DOI":"10.1155\/2018\/7618079","article-title":"Biomechanical comparison of three different intramedullary nails for fixation of unstable basicervical intertrochanteric fractures of the proximal femur: experimental studies","volume":"2018","author":"Kwak","year":"2018","journal-title":"BioMed Research International"},{"key":"10.7717\/peerj.18020\/ref-14","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":"Journal of Orthopaedic Science"},{"key":"10.7717\/peerj.18020\/ref-15","doi-asserted-by":"publisher","first-page":"2787","DOI":"10.1016\/J.INJURY.2021.08.013","article-title":"Comparison of sliding distance of lag screw and nonunion rate according to anteromedial cortical support in intertrochanteric fracture fixation: a systematic review and meta-analysis","volume":"52","author":"Lim","year":"2021","journal-title":"Injury"},{"issue":"8","key":"10.7717\/peerj.18020\/ref-16","doi-asserted-by":"publisher","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":"European Journal of 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