Intertrochanteric Femoral Fractures: A Comparison of Clinical and Radiographic Results with the Proximal Femoral Intramedullary Nail (PROFIN), the Anti-Rotation Proximal Femoral Nail (A-PFN), and the InterTAN Nail

Abstract

Background and Objectives: The aim of this study was to evaluate retrospectively the radiological and functional outcomes of closed reduction and internal fixation for intertrochanteric femoral fractures (IFF) using three different proximal femoral nails (PFN). Materials and Methods: In total, 309 individuals (143 males and 166 females) who underwent surgery for IFF using a PFN between January 2018 and January 2021 were included in the study. Our surgical team conducted osteosynthesis using the A-PFN® (TST, Istanbul, Turkey) nail, the PROFIN® (TST, Istanbul, Turkey), and the Trigen InterTAN (Smith & Nephew, Memphis, TN, USA) nail. The PFNs were compared based on age, gender, body mass index (BMI), length of stay (LOS) in intensive care, whether to be admitted to intensive care, mortality in the first year, amount of transfusion, preoperative time to surgery, hospitalisation time, duration of surgery and fluoroscopy, fracture type and reduction quality, complication ratio, and clinical and radiological outcomes. The patients’ function was measured with the Harris Hip Score (HHS) and the Katz Index of Independence in Activities of Daily Living (ADL). Results: Pain in the hip and thigh is the most common complication, followed by the V-effect. The Z-effect was seen in 5.7% of PROFIN patients. A-PFN was shown to have longer surgical and fluoroscopy durations, lower HHS values, and much lower Katz ADL Index values compared to the other two PFNs. The V-effect occurrence was significantly higher in the A-PFN group (36.7%) than in the InterTAN group. The V-effect was seen in 33.1% of 31A2-type fractures but in none of the 31A3-type fractures. Conclusions: InterTAN nails are the best choice for IFFs because they have high clinical scores after surgery, there is no chance of Z-effect, and the rate of V-effect is low.

Dual-screw versus single-screw cephalomedullary nails for intertrochanteric femoral fractures: a systematic review and meta-analysis

“…There were 310 stable (AO/OTA 31A1) and 1394 unstable (AO/OTA 31A2/A3) fractures in the InterTAN group and 192 stable and 1395 unstable fractures in the comparator group. Fourteen studies enrolled unstable fractures only, 7 studies included both stable and unstable types [ 23 , 24 , 28 – 30 , 38 , 45 ], and 2 studies did not mention fracture types [ 32 , 34 ]. As to study design, 5 were RCTs [ 23 , 26 , 30 , 41 , 44 ], 2 were prospective observational studies [ 24 , 33 ] and the others were retrospective studies.…”

“…Six studies (1063 patients) reported mortality after surgery, of which 1 reported in-hospital mortality [ 36 ], 2 reported 1-year mortality [ 34 , 42 ] and 3 reported mortality at last follow-up [ 23 , 39 , 40 ]. Meta-analysis using a fixed-effect model suggested no significant difference in mortality between InterTAN and the comparators (RR = 0.88, 95%CI 0.71 to 1.10, P = 0.266, Additional file 4 : Figure S16).…”

“…This is consistent with the results of our meta-analysis of perioperative parameters. Yet, two studies reported a shorter operative time in the InterTAN group [ 34 , 44 ], and several trials found comparable operative time between both groups. The diversity of these perioperative parameters among different studies may be owing to the difference in skill levels of surgeons and fracture complexity.…”