Comparison of two different proximal femoral nails in instabil intertrochanteric fractures concerning radiological parameters

Abstract

BACKGROUND: This study aimed to compare two different nail types (i.e., InterTan (IT) and Talon Distal Fix Nail/Lag Screw (TDFN)) used in the treatment of unstable intertrochanteric fractures in mobile patients over 65 years of age concerning radiological parameters. METHODS: Between June 2013 and August 2018, 106 patients over 65 years old who were operated on with closed reduction and internal fixation for intertrochanteric fractures were included in this single-center study. Patients were divided into two groups based on the proximal femoral nail used: the IT group and the TDFN group. These two groups were compared in terms of age, sex, complication rates and radiological parameters (i.e., reduction quality, tip apex distance (TAD), Parker index, union time, cut-out rate, and varus collapse). RESULTS: There were no differences between the groups in terms of age, sex, fracture union time as well as reduction quality measured on the first postoperative radiograph, Parker index and collodiaphysial angle. In the first postoperative radiographs, TAD was higher than 25 mm in 12 patients in the IT group and in five patients in the TDFN group. Although the number of patients with high TAD was more than that of the IT group, varus collapse and the cut-out complications were higher in TDFN nail. In the IT group, nail-dependent complications emerged in four patients (trochanter major fracture in three cases, femoral fracture in distal screw in one case), while there was no complication in the TDFN group. CONCLUSION: Intertan nail is superior to TDFN in preventing varus collapse and the cut-out complications, as well as in maintaining of radiological parameters, until fracture union. On the other hand, the higher complication rate is a disadvantage of this nail.