A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly

Abstract

BackgroundThe purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs).MethodsBetween January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups.ResultsEight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20 months (range 16–26 months). Significant differences were observed between the two groups regarding local complications (IT, n = 10 vs. PFNA-II, n = 20), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, n = 1 vs. PFNA-II, n = 8), femoral neck shortening (IT, 4.4 ± 1.1 mm vs. PFNA-II, 7.4 ± 2.4 mm), fracture healing time (IT, 14.7 ± 2.1 weeks vs. PFNA-II, 15.7 ± 2.4 weeks), femoral shaft fractures (IT, n = 0 vs. PFNA-II, n = 4), rotational loss of reduction (IT, n = 0 vs. PFNA-II, n = 9), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, n = 8 vs. PFNA-II, n = 1), operative time (IT, 71.9 ± 6.8 min vs. PFNA-II, 52.3 ± 4.0 min), intraoperative blood loss (IT, 190.6 ± 6.0 mL vs. PFNA-II, 180.9 ± 10.8 mL), fluoroscopy time (IT, 5.0 ± 0.48 min vs. PFNA-II, 2.8 ± 0.33 min), hospital stay (IT, 9.65 ± 0.95 days vs. PFNA-II, 8.58 ± 0.93 days), cut-out (IT, n = 0 vs. PFNA-II, n = 6), and tip-apex distance (IT, 26.7 ± 0.91 mm vs. PFNA-II, 23.2 ± 1.22 mm). No significant differences existed for the other observation indexes (p > 0.05).ConclusionsThe IT nail may have more advantage for patients with unstable intertrochanteric fractures of the femur. However, for those complicated with lateral greater trochanter fractures, lateral cortex fractures of the proximal femurs, or unfit for surgery, the PFNA-II nail could be a good option. In addition, a large-sample, multicenter observational study is required for evaluation of its long-term efficacy, and optimal management strategies for specific unstable fracture patterns, different sorts of bone quality, and different levels of patient demand.

Learning Curve and Clinical Outcomes of Performing Surgery with the InterTan Intramedullary Nail in Treating Femoral Intertrochanteric Fractures

“…The mean duration of surgery for InterTan intramedullary nail in the late group of patients was 64.97 (95% CI 59.59 to 70.36) min, similar to the operative time reported in earlier research that ranged from 48 to 73.91 min [4, 5, 15, 18–20], excluding one study that reported an average time that was less than 30 minutes [21]. These studies also reported that the mean operative time for GN, PFNA, or PFNA-II treatments [4, 5, 15, 18–20] was 44.41–72.98 minutes.…”

“…These studies also reported that the mean operative time for GN, PFNA, or PFNA-II treatments [4, 5, 15, 18–20] was 44.41–72.98 minutes. Of these, two studies reported that there was no significant difference in the operative time between the InterTan intramedullary nail (IT) group and the GN or PFNA group [15, 20].…”

The Results of Unstable Intertrochanteric Femur Fracture Treated with Proximal Femoral Nail Antirotation-2 with respect to Different Greater Trochanteric Entry Points

“…We got satisfactory results with PFNA-2, and there was no considerable difference between 2 groups in terms of functional outcome. e varus collapse was seen in 12% [18], 5.8% [21], and 4.9% [22] of cases in previous studies. We got 15% cases with varus collapse with screw back out in the lateral entry group.…”

Functional outcome of proximal femoral nail antirotation with helical blade fixation in extra capsular hip fractures in Himalayan region

“…Though the overall complication rate was 20% but implant failure rate was only 2.8% no cut out has been reported. Yu et al [33] in their study reported combined implant failure cut-out in 9.7 of their cases. Implant failure rate is relatively lower in cephalomedullary nails with helical blade fixation technique.…”

“…This needs early mobilization to prevent medical co-morbidies and regain preinjury activity operative management have become preferred [5] . Implants should be used which have characteristics of less invasion, allow early weight bear and have less complication [6,7] .…”