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Original Article
- A Comparative Study of TRIGENâ„¢ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures
- Jae-Hoon Jang, M.D., Jeung Il Kim, M.D., Ph.D., Um Ji Kim, M.D., Nam Hoon Moon, M.D.
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Journal of the Korean Fracture Society 2016;29(2):128-136.
DOI: https://doi.org/10.12671/jkfs.2016.29.2.128
Published online: April 19, 2016
Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea.
- Address reprint requests to: Nam Hoon Moon, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: 82-51-240-7248, Fax: 82-51-240-8395, namhoonmoon@gmail.com
• Received: July 14, 2015 • Revised: January 11, 2016 • Accepted: March 17, 2016
Copyright © 2016 The Korean Fracture Society. All rights reserved.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
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Purpose
- The primary purpose of this study was to demonstrate that the TRIGEN™ INTERTAN nail (InterTAN) could show better clinical outcome compared to the proximal femoral nail antirotation 2 (PFNA2) for treatment of intertrochanteric fracture in the elderly.
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Materials and Methods
- Between March 2009 and December 2013, 164 patients with intertrochanteric fractures who met our inclusion and exclusion criteria were enrolled in this study. Evaluation variables, including operation time, blood loss during the operation, incidence of perioperative complications, clinical results at the last follow-up, and radiographic findings were assessed for comparison of the 2 implants.
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Results
- Intraoperative lateral wall fracture was significantly higher in the PFNA2 group (p<0.05) and tip apex distance was significantly higher in the InterTAN group (p<0.05). Sliding of the proximal fragment at the last follow-up was significantly higher in the PFNA2 group. However, there was no significant difference in union rate, time to union, postoperative complications, and clinical outcomes at the last follow-up between the 2 groups.
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Conclusion
- Based on these data, clinical outcomes at the last follow-up were equivalent between InterTAN and PFNA2.
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REFERENCES
Fig. 2
(A) Preoperative hip anteroposterior (AP) radiograph of a 65-year-old male patient showing an intertrochanteric fracture (AO2-2) of the left proximal femur. (B) Postoperative radiograph showing Inter-TAN fixation of the intertrochanteric fracture. (C) At the last follow-up, union was achieved. (D) Preoperative hip AP radiograph of a 72-yearold male patient showing an intertrochanteric fracture (AO2-3) of the right proximal femur. (E) Postoperative radiograph showing proximal femoral nail antirotation 2 fixation of the intertrochanteric fracture. (F) At the last follow-up, union was achieved.
Fig. 3
(A) Intraoperative fluoroscopy of a 78-year-old female patient showing an anatomical reduction of an intertrochanteric fracture (AO1-2) of the right proximal femur before insertion of a helical blade. (B) Fluoroscopy showing an intraoperative lateral wall fracture (black arrow) during insertion of a helical blade.
Table 1
![jkfs-29-128-i001.jpg]()
Preoperative Demographic Data of Patients
Table 2
![jkfs-29-128-i002.jpg]()
Postoperative Outcome after Surgery
Table 3
![jkfs-29-128-i003.jpg]()
Complications after Surgery
Figure & Data
REFERENCES
Citations
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- Unstable Intertrochanteric Fracture: Do We Know Everything? A Review
Balaji Zacharia, Harshitha Hayavadana Udupa
SN Comprehensive Clinical Medicine.2022;[Epub] CrossRef
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XML DownloadA Comparative Study of TRIGENâ„¢ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures
Fig. 1
Flow sheet of the study. PFNA2: Proximal femoral nail antirotation 2.
Fig. 2
(A) Preoperative hip anteroposterior (AP) radiograph of a 65-year-old male patient showing an intertrochanteric fracture (AO2-2) of the left proximal femur. (B) Postoperative radiograph showing Inter-TAN fixation of the intertrochanteric fracture. (C) At the last follow-up, union was achieved. (D) Preoperative hip AP radiograph of a 72-yearold male patient showing an intertrochanteric fracture (AO2-3) of the right proximal femur. (E) Postoperative radiograph showing proximal femoral nail antirotation 2 fixation of the intertrochanteric fracture. (F) At the last follow-up, union was achieved.
Fig. 3
(A) Intraoperative fluoroscopy of a 78-year-old female patient showing an anatomical reduction of an intertrochanteric fracture (AO1-2) of the right proximal femur before insertion of a helical blade. (B) Fluoroscopy showing an intraoperative lateral wall fracture (black arrow) during insertion of a helical blade.
Fig. 1
Fig. 2
Fig. 3
A Comparative Study of TRIGENâ„¢ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures
Preoperative Demographic Data of Patients
| Characteristic | Group 1* | Group 2† | p-value |
|---|---|---|---|
| Total patients | 72 | 92 | |
| Age at surgery (yr) | 74.3±9.0 (65-95) | 74.5±9.6 (65-96) | 0.897 |
| Gender (male) | 25 (34.7) | 29 (31.5) | 0.738 |
| Affected hip (right) | 32 (44.4) | 42 (45.7) | 1.000 |
| Anesthesia (general) | 33 (45.8) | 43 (46.7) | 1.000 |
| Follow-up (mo) | 11.0±4.8 (6-36) | 12.1±7.2 (6-36) | 0.256 |
| AO type | 0.214 | ||
| A11, 12, 13 | 25 (34.7) | 37 (40.2) | |
| A21, 22, 23 | 37 (51.4) | 49 (53.3) | |
| A31, 32, 33 | 10 (13.9) | 6 (6.5) | |
| ASA | 0.915 | ||
| Class 1 | 18 (25.0) | 21 (22.8) | |
| Class 2 | 32 (44.4) | 43 (46.7) | |
| Class 3 | 22 (30.6) | 28 (30.4) | |
| Class 4 | 0 (0) | 0 (0) | |
| Mobility score before injury | 6.1±1.9 (1-9) | 6.2±1.9 (1-9) | 0.742 |
Values are presented as number only, mean±standard deviation (range), or number (%). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2. ASA: American Society of Anesthesiologists.
Postoperative Outcome after Surgery
| Variable | Group 1* (n=72) | Group 2† (n=92) | p-value |
|---|---|---|---|
| Operative time (min) | 56.2±14.4 (50-120) | 54.3±13.7 (50-120) | 0.388 |
| Blood loss (ml) | 263.9±161.7 (50-700) | 283.2±189.7 (50-700) | 0.493 |
| Postoperative drainage | 120.1 (30-550) | 110.3 (50-300) | 0.078 |
| Postoperative reduction | |||
| Anatomical | 50 (69.4) | 62 (67.4) | 0.234 |
| Acceptable | 20 (27.8) | 30 (32.6) | |
| Poor | 2 (2.8) | 0 (0) | |
| Implant position | |||
| Optimal | 60 (83.3) | 81 (88.0) | 0.498 |
| Suboptimal | 12 (16.7) | 11 (12.0) | |
| TAD (mm) | 21.7±3.3 (15-30) | 20.7±2.3 (15-30) | 0.020 |
| TAD >25 mm | 13 (18.1) | 5 (5.4) | 0.012 |
| Sliding of proximal femur (mm) | 4.1±2.3 (1.0-12.6) | 6.4±4.0 (1.2-20.2) | <0.001 |
| Bony union | 71 (98.6) | 91 (98.9) | >0.999 |
| Time to union (mo) | 5.0±2.01 (3-12) | 5.3±2.1 (3-12) | 0.379 |
Values are presented as mean±standard deviation (range), median (range), or number (%). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2. TAD: Tip apex distance.
Complications after Surgery
| Complication | Group 1* (n=72) | Group 2† (n=92) | p-value |
|---|---|---|---|
| Intraoperative complication | |||
| Lateral wall fracture | 2 (2.8) | 13 (14.1) | 0.014 |
| Fish-mouth opening | 4 (5.6) | 5 (5.4) | >0.999 |
| Postoperative complication | |||
| Hematoma formation | 2 (2.8) | 1 (1.1) | 0.582 |
| Superficial infection | 2 (2.8) | 2 (2.2) | >0.999 |
| Excessive lateral protrusion | 2 (2.8) | 11 (12.0) | 0.040 |
| Deep infection | 1 (1.4) | 1 (1.1) | >0.999 |
| General complication | |||
| Pneumonia | 8 (11.1) | 11 (12.0) | 0.867 |
| Myocardial infarction | 1 (1.4) | 0 (0) | 0.439 |
| Cerebral infarction | 1 (1.4) | 1 (1.1) | >0.999 |
| Pulmonary embolism | 1 (1.4) | 0 (0) | 0.439 |
| Deep vein thrombosis | 5 (6.9) | 10 (10.9) | 0.428 |
| Severe hemoptysis | 1 (1.4) | 0 (0) | 0.439 |
| Ulcer bleeding | 1 (1.4) | 0 (0) | 0.439 |
Values are presented as number (%). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2.
Functional Outcome at Last Follow-Up
| Variable | Group 1* (n=72) | Group 2† (n=92) | p-value |
|---|---|---|---|
| Harris hip score | 72.1±11.4 (38-96) | 70.2±9.9 (40-95) | 0.263 |
| Mobility score | 4.4±1.4 (1-8) | 4.5±1.4 (2-7) | 0.504 |
| Change in mobility score‡ | 1.5±1.0 (0-3) | 1.4±0.9 (0-5) | 0.359 |
Values are presented as mean±standard deviation (range). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2. ‡Mobility score before injury–mobility score at last follow-up.
Table 1
Preoperative Demographic Data of Patients
Values are presented as number only, mean±standard deviation (range), or number (%). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2. ASA: American Society of Anesthesiologists.
Table 2
Postoperative Outcome after Surgery
Values are presented as mean±standard deviation (range), median (range), or number (%). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2. TAD: Tip apex distance.
Table 3
Complications after Surgery
Values are presented as number (%). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2.
Table 4
Functional Outcome at Last Follow-Up
Values are presented as mean±standard deviation (range). *A group underwent InterTAN nail. †A group underwent proximal femoral nail antirotation 2. ‡Mobility score before injury–mobility score at last follow-up.
