The Results of Unstable Intertrochanteric Femur FractureTreatedwithProximalFemoralNailAntirotation-2withrespecttoDifferent Greater Trochanteric Entry Points

Proximal femoral nail antirotation-2 (PFNA-2) has been widely used to treat intertrochanteric fractures with variedoutcomes in the previous studies. *e entry point of the nail plays an important role in achieving acceptable reduction, stablefixation,andavoidingimplantrelatedcomplications.*isstudywasproposedtodeterminetheoptimalgreatertrochantericentrypoint for PFNA-2 in unstable intertrochanteric femur fractures.Methods. We conducted an observational study on 40 patientswith unstable intertrochanteric fracture treated with PFNA-2 implant in a tertiary care hospital. *e patients were grouped intotwo based on the entry point: group L for lateral and group M for medial entry. Randomization was carried out by assigning thepatientstothegroupbyalternateallocation.*equalityofreduction,tipapexdistance,Clevelandindex,andallthecomplicationswere noted. *e final follow-up was conducted at six months. *e functional outcome was evaluated using modified Harris hipscore. *e data analysis was performed using Student’st-test, chi square test, and Mann–Whitney test. APvalue below 0.05 wasconsidered significant.Results. Forty patients with 20 patients treated with medial entry point were included in group M and 20patients in group L with lateral entry point. *e group L had an average tip apex distance of 20.53 and group M had 20.02(P�0.8). *e complicationof screw back out was seen in3 out of 4 patients withpoor reduction in group L. Asper the Clevelandindex,6patientsineachgrouphadsuboptimalpositionand4outof6patientsingroupLwithsuboptimalpositionhadscrewbackout. *e lateral cortex impingement was seen in 14 patients of group L and 6 patients in group M with significant comparison(P�0.01). *ree patients in group L had varus collapse with screw back out. Also, none in group M (0.05). *e average modifiedHarrishipscoreingroupLatsixmonthsfollow-upwas71.94and76.8ingroupM(P�0.84).Conclusion.Overall,toachievegoodquality of fixation and reducing damage to gluteus medius entry point for PFNA-2 should be 5mm medial to the greatertrochanter tip.