3 years ago

Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures

Gopalan, Hitesh, Srinivasan, Parthasarathy, S, Santosh, Gavaskar, Ashok S., Tummala, Naveen C., Karthik, Bhupesh
Objectives: To compare the radiological and clinical results with PFNA-II and InterTan in the treatment of unstable trochanteric fractures in the elderly. Design: Retrospective, multicenter, matched pair. Setting: Three tertiary level trauma centers. Patients: Hundred elderly patients who underwent intramedullary stabilization with either the PFNA-II or the InterTan for osteoporotic unstable trochanteric fractures. Interventions: Fifty matched pairs consisting of OTA/AO–A2 and A3 fractures were created from a cohort of 290 patients who underwent internal fixation for unstable trochanteric fractures with the PFNA-II or InterTan nails. Outcome Measurements: Radiological assessment was performed to compare union rates, varus collapse, medial or lateral screw/blade migration, and cut-out. Functional outcome at 1 year was assessed and compared using Harris hip score, Timed Up and Go test, and the mobility score. Results: Union rates, fracture reduction, neck shaft angle, and tip–apex distance were similar in both groups. The PFNA-II group had a significantly higher degree of lateral sliding of the helical blade (P < 0.001). The InterTan group had a better Harris hip score, mobility score, Timed Up and Go test scores, and abductor strength (P < 0.05) at 1 year. The incidence of varus collapse and medial blade migration were higher in the PFNA-II group (P > 0.05). The need for repeat surgery to address surgery-related complications were significantly high in the PFNA-II group (P = 0.045). Conclusions: The InterTan may provide superior functional outcome and reduced complications than does the Proximal Femur Nail - Antirotation in elderly patients with unstable trochanteric fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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