Comparative evaluation of locked and unlocked blade proximal femoral nail antirotation implants in the treatment of trochanteric fractures based on reduction quality and clinical success criteria.

OBJECTIVE: This study aimed to compare the reduction quality and clinical outcomes of locked and unlocked blade variants of the proximal femoral nail antirotation (PFNA) system in the treatment of trochanteric fractures in patients aged >65 years with similar demographic and clinical profiles. METHODS: A total of 314 patients treated for trochanteric fractures between 2013 and 2020 were retrospectively analyzed. Patients were grouped according to whether locked (n = 160) or unlocked (n = 164) blade PFNA implants were used. Baseline characteristics including age, gender, comorbidities, and fracture type were similar across groups. Surgical parameters, radiological measurements, postoperative complications, and clinical outcomes (Harris Hip Score, Visual Analog Scale) were compared. The use of unlocked blade implants was gradually replaced by locked blade implants after 2017 due to changes in reimbursement regulations. RESULTS: The locked group had significantly longer operation time and greater intraoperative bleeding. No significant difference was found in reduction quality between groups (p > 0.05). Radiologically, Parker ratio AP was higher in the locked group, whereas type apex distance, calcar-referenced distance, and cervical angle difference were greater in the unlocked group (p < 0.05). VAS was higher in the locked group at 6 weeks (p < 0.05). Postoperative complications were more frequent in the locked group, although nonunion rates were not significantly different (p > 0.05). Long-term clinical scores showed no significant difference (p > 0.05). The unlocked group had significantly longer follow-up duration (p < 0.05). CONCLUSIONS: While both implant types provided comparable clinical and radiological outcomes, the unlocked PFNA group showed advantages in terms of surgical efficiency and lower complication rates.