Jae-Hoon Jang; Jeung Il Kim; Um Ji Kim; Nam Hoon Moon

doi:10.12671/jkfs.2016.29.2.128

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Jang, Kim, Kim, and Moon: A Comparative Study of TRIGEN™ INTERTAN Nail (InterTAN) and Proximal Femoral Nail Antirotation 2 (PFNA2) in the Patients with Intertrochanteric Fractures

Original Article

Journal of the Korean Fracture Society 2016; 29(2): 128-136.

Published online: 19 April 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.2.128

A Comparative Study of TRIGEN™ 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.

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 14 July 2015 Revised 11 January 2016 Accepted 17 March 2016

(open-access):

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.

Abstract

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.

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.

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.

Conclusion

Based on these data, clinical outcomes at the last follow-up were equivalent between InterTAN and PFNA2.

Keywords: Intertrochanteric fractures, PFNA2, InterTAN

Figures and Tables

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.

Table 1

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.

Table 2

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.

Table 3

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.

Table 4

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.

Notes

^{Financial support} This research was supported by grant from the Pusan National University Hospital, 2015.

^{Conflict of interest} None.

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