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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2017 | Research article

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years

Authors: Hui Zhang, Xiaoxiao Zhu, Genwang Pei, Xianshang Zeng, Nan Zhang, Ping Xu, Deng Chen, Weiguang Yu, Xinchao Zhang

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2017

Abstract

Background

The study aims to compare the long-term functional and radiographic outcomes of two devices for the treatment of primary intertrochanteric fractures (IFs, OTA 3.1A2.1–A2.3) in elderly patients with osteoporosis.

Methods

Between December 2010 and August 2014, 332 elderly osteoporosis patients with IFs (OTA 3.1A2.1–A2.3) fixed by an InterTAN nail (IT) or a proximal femoral nail anti-rotation (PFNA) device were retrospectively evaluated. Follow-up occurred 1, 3, 6, and 12 months postoperatively and every year thereafter. Mortality was recorded. Patient-related functional and radiographic outcomes were compared. The primary endpoint was the long-term radiographic outcomes. The secondary endpoint was the long-term functional outcomes.

Results

A total of 283 patients (283 hips) with osteoporosis (IT, n = 144; PFNA, n = 139) were evaluated with a mean follow-up period of 38.8 months (range, 36–43 months). No between-group significant differences were noted in the patient demographics, operation variables, and postoperative Harris Hip Score. More radiographic complications were noted in terms of screw cut-out, femoral shaft fracture distal or around the tip of the main nail, and varus collapse of the femoral head in the PFNA group compared with that in the IT group (P < 0.05).

Conclusion

For osteoporotic IFs (OTA 3.1A2.1–A2.3) in elderly patients, the use of IT aids in decreasing radiographic complications, but the between-group functional outcomes showed no significant difference.

PRJ P, Lord R, Jawad A, Dawe E, Stott P, Rogers B, Gill R. Changing trends in the management of intertrochanteric hip fractures—a single centre experience. Injury. 2016;47(7):1525–9.CrossRef

Kanakaris NK, Tosounidis TH, Giannoudis PV. Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked. J Orthop Trauma. 2015;29:S10–6.CrossRefPubMed

Seyhan M, Turkmen I, Unay K, Ozkut AT. Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study. J Orthop Sci. 2015;20(6):1053–61.CrossRefPubMed

Li MH, Wu L, Liu Y, Wang CM. Clinical evaluation of the Asian proximal femur intramedullary nail antirotation system (PFNA-II) for treatment of intertrochanteric fractures. J Orthop Surg Res. 2014;9

Zha G-C, Chen Z-L, Qi X-B, Sun J-Y. Treatment of pertrochanteric fractures with a proximal femur locking compression plate. Injury. 2011;42(11):1294–9.CrossRefPubMed

Henzman C, Ong K, Lau E, Seligson D, Roberts CS, Malkani AL. Complication risk after treatment of intertrochanteric hip fractures in the Medicare population. Orthopedics. 2015;38(9):E799–805.CrossRefPubMed

Kleweno C, Morgan J, Redshaw J, Harris M, Rodriguez E, Zurakowski D, Vrahas M, Appleton P. Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma. 2014;28(7):391–7.CrossRefPubMed

Boone C, Carlberg KN, Koueiter DM, Baker KC, Sadowski J, Wiater PJ, Nowinski GP, Grant KD. Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2). J Orthop Trauma. 2014;28(5):E96–E100.CrossRefPubMed

Wang X, Yu G-R. Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures. Clin Orthop Relat Res. 2013;471(7):2408–10.CrossRefPubMedPubMedCentral

10.

Menezes DFA, Gamulin A, Noesberger B. Is the proximal femoral nail a suitable implant for treatment of all trochanteric fractures? Clin orthop relat research. 2005;439:221–7.CrossRef

11.

Kim WY, Han CH, Park JI, Kim JY. Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop. 2001;25(6):360–2.CrossRefPubMedPubMedCentral

12.

Shayesteh-Azar M, Karimi-Nasab MH, Sajjadi-Saravi M, Daneshpoor SMM, Hadian A, Olia G. Comparison of surgical complications of intertrochanteric hip fractures between non-osteoporotic and osteoporotic patients. J Pak Med Assoc. 2013;63(6):752–5.PubMed

13.

Huang TW, Chuang PY, Lin SJ, Lee CY, Huang KC, Shih HN, Lee MS, Hsu RWW, Shen WJ. Teriparatide improves fracture healing and early functional recovery in treatment of osteoporotic intertrochanteric fractures. Medicine. 2016;95(19):e3626.CrossRefPubMedPubMedCentral

14.

Yu W, Zhang X, Zhu X, Hu J, Liu Y. 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. J Orthop Surg Res. 2016;11

15.

Hartford JM, Patel A, Powell J. Intertrochanteric osteotomy using a dynamic hip screw for femoral neck nonunion. J Orthop Trauma. 2005;19(5):329–33.PubMed

16.

Zhang S, Zhang KR, Jia YF, Yu B, Feng W. InterTan nail versus proximal femoral nail antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013;36(3):E288–94.CrossRefPubMed

17.

Mereddy P, Kamath S, Ramakrishnan M, Malik H, Donnachie N. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury. 2009;40(4):428–32.CrossRefPubMed

18.

Ruecker AH, Rupprecht M, Gruber M, Gebauer M, Barvencik F, Briem D, Rueger JM. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma. 2009;23(1):22–30.CrossRefPubMed

19.

Li S, Chang SM, Jin YM, Zhang YQ, Niu WX, Du SC, et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury. 2016;47(6):1302–8.CrossRefPubMed

20.

Santoni BG, Nayak AN, Cooper SA, Smithson IR, Cox JL, Marberry ST, Sanders RW. Comparison of femoral head rotation and varus collapse between a single lag screw and integrated dual screw intertrochanteric hip fracture fixation device using a cadaveric Hemi-Pelvis biomechanical model. J Orthop Trauma. 2016;30(4):164–9.CrossRefPubMed

21.

Rupprecht M, Grossterlinden L, Sellenschloh K, Hoffmann M, Puschel K, Morlock M, Rueger JM, Lehmann W. Internal fixation of femoral neck fractures with posterior comminution. A biomechanical comparison of DHS (R) and Intertan nail (R). Int Orthop. 2011;35(11):1695–701.CrossRefPubMedPubMedCentral

22.

Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;8

23.

Raviraj A, Anand A, Chakravarthy M, Pai S. Proximal femoral nail antirotation (PFNA) for treatment of osteoporotic proximal femoral fractures. European J Orthop Surg Traumatol. 2012;22(4):301–5.CrossRef

24.

Niikura T, Lee SY, Matsumoto T, Fukui T, Kawakami Y, Akisue T, Kuroda R, Kurosaka M. Backout of the helical blade of proximal femoral nail antirotation and accompanying fracture nonunion. Orthopedics. 2012;35(8):E1264–6.CrossRefPubMed

25.

de Landevoisin ES, Bertani A, Candoni P, Charpail C, Demortiere E. Proximal femoral nail antirotation (PFN-ATM) fixation of extra-capsular proximal femoral fractures in the elderly: retrospective study in 102 patients. Orthop Traumatol Surg Res. 2012;98(3):288–95.CrossRef

26.

Andruszkow H, Frink M, Fromke C, Matityahu A, Zeckey C, Mommsen P, Suntardjo S, Krettek C, Hildebrand F. Tip apex distance, hip screw placement, and neck shaft angle as potential risk factors for cut-out failure of hip screws after surgical treatment of intertrochanteric fractures. Int Orthop. 2012;36(11):2347–54.CrossRefPubMedPubMedCentral

Title: A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years
Authors: Hui Zhang
Xiaoxiao Zhu
Genwang Pei
Xianshang Zeng
Nan Zhang
Ping Xu
Deng Chen
Weiguang Yu
Xinchao Zhang
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2017
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-017-0648-2

At a glance: The STEP trials

Springer Medicine

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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