Helical Blade or the Integrated Lag Screws: A Matched Pair Analysis of 100 Patients With Unstable Trochanteric Fractures. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Gavaskar, Ashok S.; Tummala, Naveen C.; Srinivasan, Parthasarathy; Gopalan, Hitesh; Karthik, Bhupesh; S, Santosh
• Is Part Of: Journal of orthopaedic trauma. Volume 32:Issue 6(2018)
• Publication Date: 2018-06
• Subjects: PFNA-II -- helical blade -- InterTan -- integrated screws -- trochanteric fractures; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000001145
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is Available in the Text.