Short Versus Long InterTAN Fixation for Geriatric Intertrochanteric Hip Fractures: A Multicentre Head-to-Head Comparison

Abstract

Objective: To determine if geriatric intertrochanteric hip fracture patients achieve equivalent postoperative functional status after management with either a short (180-200 mm) or a long (260-460 mm) InterTAN intramedullary device. Design: Retrospective review of a prospective randomized control trial. Setting: Four Level I Trauma Centers. Patients/Participants: One hundred eight patients with OTA/AO classification 31A-1 and 31A-2 intertrochanteric hip fractures were included in the study. Intervention: Internal fixation using an IT device. Main Outcomes Measures: Primary outcomes included Functional Independence Measure and Timed Up and Go. Secondary outcomes included blood loss, surgical time, length of stay, adverse events, and mortality. Results: Seventy-one short and 37 long IT patients met study inclusion criteria. Demographics were similar between groups. There was no difference in Functional Independence Measure or Timed Up and Go scores between the 2 IT groups at any of the time points collected. Mean operative time was lower in the short IT group than in the long IT group (60 vs. 73 minutes; P = 0.021). A higher proportion of long IT patients had reamed constructs (95% vs. 48% short IT, P < 0.001). Postoperative blood loss was significantly higher in the long IT group without a significant influence on the number of patients requiring transfusion (P = 0.582) or average units transfused (P = 0.982). There was no significant difference in the proportion of postoperative adverse events between the 2 cohorts despite a higher number of peri-implant femur fractures in the short IT group than in the long IT group (5 vs. 1, P = 0.350). Conclusions: Postoperative functional status was not influenced by the length of IT device in the management of geriatric intertrochanteric hip fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Clinical outcomes following long versus short cephalomedullary devices for fixation of extracapsular hip fractures: a systematic review and meta-analysis

“…Five studies included information on the number of patients requiring blood transfusion, however only Boone et al . reported that there was a statistically significant difference in transfusion rates 18 , 25 – 27 , 31 .…”

“…and Shannon et al . , had a randomised controlled trail (RCT) design 27 , 28 , 33 . The remaining thirteen studies were retrospective cohort studies.…”

Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

“…Sellan et al observed a better HHS for the short nail group, but did not find any significance from the clinical point of view. One hypothesis is that usually, cases with such fractures are geriatric patients with low motor functions required to return to the baseline (26).…”

Application of Wire-Assisted Reduction Guided by Minimally Invasive Wire Introducer in the Treatment of Irreducible Femoral Intertrochanteric Fractures

“…Reduction was the key factor to determine the operative effect of intertrochanteric fracture of femur [9]. Many complications, such as hip varus, loosening of internal xation, and refracture, were associated with poor reduction [10]. Poor reduction was more common in irreducible fractures.…”

“…Prolonged bedridden could lead to pressure sores, pneumonia, deep vein thrombosis and other complications, and can lead to death. So the intertrochanteric fracture was called the "last fracture of life" [1]. Therefore, surgical treatment was the preferred choice for intertrochanteric fractures.…”