Proximal femoral nail anti-rotation with and without cable cerclage for intertrochanteric femoral fractures with vulnerable lateral wall: a retrospective cohort study

The purpose of this study was to compare the surgical outcomes, perioperative and after-discharge structural and functional recovery of proximal femoral nail anti-rotation (PFNA) combined with and without cable cerclage for intertrochanteric femoral fractures with vulnerable lateral wall. In this retrospective analysis, 80 patients of intertrochanteric femoral fractures with vulnerable lateral wall were divided into two groups according to internal fixation: 60 in the PFNA group (group P) and 20 in the PFNA combined with cable cerclage group (group PCC). Postoperative complications and functional outcomes were assessed. The mean follow-up was 23.34 ± 2.85 months in the P group versus 24.85 ± 3.42 ones in PCC group without statistical significance. The PCC group exhibited significantly longer surgical time, fluoroscopy time, shorter fracture union, partial weight-bearing time and less neck-shaft angle change than those in the P group (p value < 0.05). Harris Hip Score (HHS) at 3, 6 months was higher in the PCC group (p value < 0.001). However, no significant differences were observed between the two groups regarding blood loss, Visual Analogue Scale (VAS) score, tip-apex distance (TAD), HHS at 12, 18 months and full weight-bearing time (p value > 0.05). Furthermore, no significant differences were noted in postoperative complications. The PFNA with and without cable cerclage both demonstrated similar and satisfactory functional outcomes and relatively-low complication rates in patients with vulnerable lateral wall in intertrochanteric femoral fractures. The PCC group was superior in accelerating bone union, minimizing hip deformity and promoting early rehabilitation.