Rotationally Stable Fixation for Intertrochanteric Hip Fractures: The Intertan Experience, Surgical Technique, and Outcomes

Abstract

The surgical stabilization of intertrochanteric fractures remains a persistent challenge. The purpose of this paper was to describe the surgical technique and analyze the outcomes of these fractures treated with a novel intramedullary (IM) device that provides rotational stability, in addition to prompting compression across the fracture.

In this IRB approved retrospective study, consecutive patients with peritrochanteric hip fractures were treated with an (Intertan) (a fourth generation proximal hip nail) IM nail. Clinical examination and radiographic analysis was obtained at routine intervals. Clinical and radiographic outcome parameters were evaluated. Outcome measurements included time to union, reoperating rate, change of femoral neck-shaft angle, migration of the lag screw, degree of lag screw telescoping, and tip-to-apex distance. Factors that may have affected outcomes were determined statistically.

A total of 20 patients were lost to follow-up with 80 patients available for long-term follow-up with complete data for statistical analysis. The majority of fractures (79%) were classified as unstable (OTA 31-A2). All fractures healed. The average time to union was 12.9 weeks. No patients sustained any intraoperative complications. One patient required revision surgery secondary to a peri prosthetic. Three patients demonstrated partial lag screw cut-out, but the fracture’s healed in an acceptable position. Six patients had leg shortening >1 cm, and 2 patients had femoral neck-shaft angle progression of >10 degrees. Further x-ray review demonstrated average change in neck-shaft angle of 3.1 degrees, average lag screw migration of 3.9 mm, and average lag screw telescoping of 3.8 mm. Radiologic changes occurred within the first 8 weeks postoperation. None of the previous shown determinants such as tip-to-apex distance, quality of reduction, and position of the lag screw appeared to significantly affect the small incidence of varus collapse, lag screw migration, and telescoping that we observed.

We demonstrated the Intertan ability to function as an effective IM device for unstable intertrochanteric fractures. The implants’ unique design imparts substantial rotational stability and functions effectively to block excessive subsidence. This rotational stability seems to be unique to current IM hip fixation devices and warrants further randomized clinical trial to demonstrate its efficacy.