Cephalomedullary Nail Fixation of Intertrochanteric Femur Fractures: Are Two Proximal Screws Better Than One?

• Published in: Journal of orthopaedic trauma Vol. 31; no. 11; p. 577
• Main Authors: Serrano, Rafael, Blair, James A, Watson, David T, Infante, Jr, Anthony F, Shah, Anjan R, Mir, Hassan R, Maxson, Benjamin J, Downes, Katheryne L, Sanders, Roy W
• Format: Journal Article
• Language: English
• Published: United States 01.11.2017
• Subjects: Aged; Aged, 80 and over; Bone Screws; Cohort Studies; Confidence Intervals; Equipment Design; Female; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Fracture Healing - physiology; Hip Fractures - diagnostic imaging; Hip Fractures - surgery; Humans; Internal Fixators; Middle Aged; Postoperative Complications - physiopathology; Postoperative Complications - surgery; Range of Motion, Articular - physiology; Recovery of Function; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Trauma Centers; Treatment Outcome; United States
• ISSN: 1531-2291
• DOI: 10.1097/BOT.0000000000000967

To analyze radiographic changes in intertrochanteric (IT) fracture alignment after treatment with either a single sliding lag screw or an integrated compressed and locked, dual screw, cephalomedullary nail construct. Retrospective comparative study. Level 1 regional trauma center. 1004 OTA/AO 31A, 31B2.1 fractures treated with either a single screw cephalomedullary nail (Gamma 3) or an integrated dual screw cephalomedullary nail (InterTAN) between February 1, 2005, and June 30, 2013. Four hundred thirteen remained after exclusion criteria; 130 were treated with a single screw device (79 stable and 51 unstable), and 283 with an integrated dual screw device (155 stable and 128 unstable). Cephalomedullary nail insertion. Radiographic analysis included fracture pattern, fracture reduction, neck-shaft angle (NSA), and femoral neck shortening (FNS) differences at 3, 6, and 12 months. Measurements were normalized using known lag screw dimensions, digitally corrected for magnification. Rotation between x-rays was controlled using a ratio of known to measured dimensions. The Mann-Whitney U test was used for statistical analysis. The single screw device resulted in 2.5 times more varus collapse (NSA) and 2 times more FNS over 1 year, as compared to the locked, integrated dual screw device, regardless of stability (P < 0.001). NSA and FNS changes were greater for both devices in unstable fracture patterns, but significantly less movement occurred with the dual screw device (P < 0.001). A cephalomedullary nail with 2 integrated proximal screws that can be compressed and then locked seems to maintain initial IT fracture reduction and subsequent position over time, with less varus collapse and less shortening than a single screw device. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.