Optimizing stability in AO/OTA 31-A2 intertrochanteric fracture fixation in older patients with osteoporosis

Abstract

ObjectivesTo compare the functional and radiographic outcomes of InterTAN nail (IT) and proximal femoral nail anti-rotation (PFNA) for managing primary AO/OTA 31-A2 intertrochanteric hip fractures (IHFs) in older osteoporotic patients.MethodsPatients aged 60 years or older who received surgical treatment for IHFs (AO/OTA 3.1A2.1-A2.3) with IT or PFNA were retrospectively evaluated. The primary outcome was the postoperative treatment failure rate. The secondary outcome was the Harris Hip Score (HHS).ResultsA total of 326 osteoporotic cases (326 hips: IT, n = 162; PFNA, n = 164) were assessed with a mean follow-up of 43.5 months (range, 38–48 months). For the entire cohort, the incidence of postoperative treatment failure (periprosthetic fracture and reoperation) was 29/326 (8.9%); the IT-treated cohort (7/162, 4.3%) had a significantly lower rate compared with the PFNA-treated cohort (22/165, 13.3%). The incidence of postoperative periprosthetic fractures was significantly lower in the IT-treated cohort than in the PFNA-treated cohort (2.5% vs 7.9%). The postoperative HHS at the final follow-up was not significantly different between the groups.ConclusionIT might show a better outcome in managing osteoporotic AO/OTA 31-A2 IHFs in terms of periprosthetic fracture and reoperation compared with PFNA.

Comparison of clinical and radiological outcomes in intertrochanteric fractures treated with InterTAN nail against conventional cephalomedullary nails: a systematic review

“…Five studies [ 12–14 , 19 , 20 ] reported the impact of IT compared with PFNA on blood loss, and three [ 16–18 ] compared IT with Gamma3. Three studies reported that patients with IT had significantly increased blood loss compared with those with PFNA (p < 0.001; p < 0.05; p = 0.012) [ 12–14 ].…”

“…However, of the remaining four studies comparing IT and PFNA, three found a significantly greater periprosthetic fracture incidence with PFNA than IT [ 15 , 19–21 ]. Zhang et al did not specify fracture type; however, they did report a greater periprosthetic fracture rate in the PFNA group (p = 0.004) [ 20 ].…”

Stabilisation of AO OTA 31-A unstable proximal femoral fractures: Does the choice of intramedullary nail affect the incidence of post-operative complications? A systematic literature review and meta-analysis

“…The most frequently reported functional outcome was the Harris Hip Score (HHS) with ten studies reporting this outcome for patients with unstable fractures [12,15,16,18,[37][38][39]41,43,44] . No significant differences were seen between groups for HHS for any comparison (data not shown, p = 0.18 for INTERTAN vs other IM nails in unstable fractures).…”

Effect of lesser trochanter posteromedial wall defect on the stability of femoral intertrochanteric fracture using 3D simulation

“…Femoral intertrochanteric fracture is the most common type of osteoporotic fracture of the hip, and it most often occurs in elderly (average age 70 years) females [1,2]. Such patients are confined to bed, and due to no off-bed activity, severe complications are developed, and a high rate of mortality is experienced in them [3].…”