• Kardo Mohammed Salih Hassan Department of Orthopedics, Shar Teaching Hospital, Directorate of Health, Sulaimani, Kurdistan Region, Iraq.
  • Areewan Mohammed Salih Saeed Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.




Proximal femoral nail, Tip apex distance, Intertrochanteric fracture, Singh index, Cleveland index



Intertrochanteric fracture (ITF) is one of the most common injuries in older people and is more prevalent in females. Thus, we aimed to compare two proximal femoral nail screw positions (centre-centre and posteroinferior) in stable ITF types.


To determine better techniques for screw placement, especially in the emergency department.

Patients and Methods

Prospectively and retrospectively, 76 (33 males and 43 females) patients aged > 55 years were registered; 44 of them were treated with proximal femoral nails with screw positions centre-centre inside the femoral neck (group A), and 32 patients treated with proximal femoral nail with screw positions posteroinferior inside the femoral neck (group B). They were followed up after 3, 6, and 12 months postoperatively to compare screw position effect on implant failure and functional outcome using MHHS. The reduction quality was assessed using neck-shaft angle (NSA), while the quality of Fixation was assessed using tip-apex distance (TAD) and calcar tip-apex distance (CalTAD). Singh index (SI) was used for osteoporosis assessment.


The mean age of patients was 72.93±8.4 (group A) and 70.13±6.86 (group B). There was no significant correlation in incidences of implant failure among TAD (<25 mm) and CalTAD (>25 mm) in group A. For group B in Cleveland index (CI) areas 8 and 9, TAD and CalTAD were ≥ 25 mm, and there were no correlations with end-result and implant failure. In group A, 2 cases of implant-related complications were recorded; in group B, one patient was recorded. The functional score was higher in group B. Fixation quality between the two groups remained comparable. 


The functional outcome of group B was better with optimal surgical conditions. Both groups had comparable radiological and Fixation failure outcomes.


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How to Cite

Hassan K, Saeed A. EFFECT OF POSTEROINFERIOR LAG SCREW POSITION FOR CEPHALOMEDULLARY NAIL ON IMPLANT FAILURE AND FUNCTIONAL OUTCOME COMPARED TO THE CENTER-CENTER POSITION IN INTERTROCHANTERIC FRACTURE. JSMC [Internet]. 2023 Mar. 21 [cited 2024 Jul. 21];13(1):1-11. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10391

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