Melt the lard/butter and olive oil in a large pot over medium-high heat. When the fat begins to shimmer, add the pork shoulder and cook, turning occasionally, until browned, about 10 minutes, then remove the pork and set aside.
Reduce the heat to medium, add the pancetta, and cook until the fat has rendered, about 10 minutes. Add the onions, celery, carrots, nutmeg and pinch of salt. Cook until the vegetables are soft and onions are translucent, around 15-20 minutes.
Add the tomato paste and cook until it turns a deep red, about 2 minutes. Add the wine, scraping up any bits stuck to the bottom of the pan, 2-4 minutes. Add the tomatoes and pork and enough water to cover, then season with salt. Reduce the heat to low and simmer until the pork is fork-tender, 1-2 hours. Keep the pork at least halfway submerged adding water as needed.
Check for doneness frequently after the 1 hour mark. When a toothpick or fork easily goes through the meat, it's finished. Season with salt and pepper.
Meanwhile, bring a large pot of salted water to a rolling boil. Add the fusilli and cook based on package directions until al dente.
Drain the pasta, reserving the cooking water, and add to the ragu, stirring to coat. Add some pasta cooking water to loosen the sauce. Cook, stirring occasionally, until the sauce loosely clings to the pasta, about 1 minute.
Serve sprinkled with parmesan cheese.