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

Quartley, Megan; Chloros, George D.; Papakostidis, K.; Saunders, Chris; Giannoudis, PV

doi:10.1016/j.injury.2022.02.002

Cited by 22 publications

(28 citation statements)

References 34 publications

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“…However, Kumbaracı et al [ 13 ] discovered in their study that, even though 72% of patients had thigh or hip pain, it had no impact on functional results. Quartley et al conducted a meta-analysis in 2022 comparing the InterTAN implant to different existing nails for unstable fractures and concluded that the InterTAN nail reduced implant-related failure, re-intervention rates, and hip and thigh pain without impacting recovery results [ 27 ]. The current study did not reveal any significant difference in hip and thigh pain between implant types.…”

Section: Discussionmentioning

confidence: 99%

“…There was a total of six individuals who suffered the Z-effect following PROFIN; however, no patients experienced the reverse Z-effect. The InterTAN nail is designed to improve rotational stability for hip fracture patients by using two interlocking lag screws (not independent) near the proximal end to construct a locking mechanism [ 27 ]. It is possible that this might help prevent problems such as femoral neck erosion, varus collapse, and unnatural shortening [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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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

Yalın¹,

Gölgelioğlu²,

Key

2023

Medicina

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Yalın¹,

Gölgelioğlu²,

Key

2023

Medicina

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“…Moreover, the proximal end of the InterTAN nail has a trapezoidal shape, which results in more material being present on the lateral side of the implant, improving the ability of the lateral wall to support and resist stress [ 14 ]. Several biomechanical studies indicate that InterTAN nails have more advantages in terms of strength, stability, and resistance to bending and rotation than Gamma 3 and PFNA nails [ 15 ]. Additionally, clinical research has confirmed its advantages.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, clinical research has confirmed its advantages. Recently, a systematic literature review and meta-analysis carried out by Quartley et al [ 15 ] in 2022 compared InterTAN and other available nails, showing that the use of InterTAN nails reduced the risk of revision/reoperation by 64%, implant failure by 62%, and hip and thigh pain by 50% in AO OTA 31-A unstable proximal femoral fractures. Our study confirmed these findings, demonstrating satisfactory clinical and radiological results with long InterTAN nails.…”

Section: Discussionmentioning

confidence: 99%

“…Multiregion fixation and high stress tolerance must be considered when selecting intramedullary nails for Type V fractures, as they involve subtrochanteric and intertrochanteric regions simultaneously. The InterTAN nail is specifically designed for intertrochanteric fractures and has unique anti-rotation and linear pressurization advantages [ 14 , 15 ]. Theoretically, it is more suitable for Type V fractures.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive clamp-assisted reduction and long InterTAN nail fixation for Seinsheimer type V subtrochanteric fractures: a case series describing the technique and results

Wang

et al. 2023

BMC Musculoskelet Disord

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Background Surgical treatment of Seinsheimer type V subtrochanteric fractures is extremely challenging due to the difficulty of obtaining and maintaining anatomic reduction and effective fixation. The purpose of this study was to describe a surgical technique for minimally invasive clamp-assisted reduction and long InterTAN nail fixation to manage Seinsheimer type V subtrochanteric fractures and report the clinical and radiological results. Methods A retrospective study was conducted on patients with Seinsheimer type V subtrochanteric fractures between March 2015 and June 2021. A total of 30 patients treated via minimally invasive clamp-assisted reduction, long InterTAN nail fixation and selective augmentation with a cerclage cable were included. The following data were collected and evaluated: patient demographics, operative time, blood loss, reduction quality, tip apex distance (TAD), time to bone union, Harris hip score (HHS), visual analog score (VAS), and complications. Results The mean age of the 30 patients was 64.8 years (range: 36-90 years). The mean operative time was 102.2 min (range: 70-150 min). The mean loss of blood was 318.3 ml (range: 150-600 ml). The reduction quality involved 27 cases of anatomic reduction and 3 cases of satisfactory reduction. The mean TAD was 16.3 mm (range: 8-24 mm). The mean follow-up time was 18.9 months (range: 12-48 months). The mean fracture healing time was 4.5 months (range: 3-8 months). The mean Harris score was 88.2 (range: 71-100), and the VAS score was 0.7 (range: 0-3). Delayed union of the subtrochanteric fracture site occurred in two patients. The limb length discrepancy, which was determined in 3 patients, was < 10 mm. There were no significant complications. Conclusion Our results indicate that minimally invasive clamp-assisted reduction with long InterTAN nail fixation is encouraging for Seinsheimer Type V subtrochanteric fractures, resulting in excellent reduction and fixation. Additionally, this reduction technique is simple, reliable, and effective in reducing and maintaining subtrochanteric fractures, particularly when intertrochanteric fractures are irreducible.

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Tautening effect mechanism of titanium-alloy InterTAN nail

Gao,

Ma,

Chen

et al. 2023

Rare Met.

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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

Cited by 22 publications

References 34 publications

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

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

Minimally invasive clamp-assisted reduction and long InterTAN nail fixation for Seinsheimer type V subtrochanteric fractures: a case series describing the technique and results

Tautening effect mechanism of titanium-alloy InterTAN nail

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