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Both InterTAN, sliding hip screws seen as effective for treatment of intertrochanteric hip fractures
Although most patients with intertrochanteric hip fractures can be effectively treated with either sliding hip screws or use of the InterTAN intermedullary device, the InterTAN device provided improved outcomes for active, functional patients with unstable intertrochanteric fractures, according to results.
Researchers randomly assigned 249 patients aged 55 years or older with intertrochanteric hip fractures to receive treatment with either sliding hip screws or the InterTAN intramedullary device (Smith & Nephew). Researchers used the functional independence measure and the timed up-and-go test to measure function and motor performance. Other measures included femoral shortening, complications and mortality.
Results showed both groups had similar demographics, comorbidities, preinjury function independence measures and timed up-and-go scores. Researchers noted limb shortening greater than 2 cm in 42.9% of patients who received sliding hip screws vs. 17.2% of patients who received an InterTAN intermedullary device. In a subgroup of patients with the ability to walk 150 meters independently preinjury and had an OA/OTA 31A-2 fracture, patients who had sliding hip screws demonstrated greater shortening and poorer function independence measure and timed up-and-go scores, according to results. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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This study demonstrates the widely held concept that treatment of intertrochanteric hip fractures in this particular patient population is generally implant-independent. Treatment with either a sliding hip screw (SHS) or cephalomedullary device with integrated rotational control (InterTAN) did not greatly influence outcomes with regard to functional capabilities or their radiographic indices. This has been reported in prior randomized trials and meta-analyses following hip fracture treatment. Most intramedullary implants used in these studies lacked the rotational control afforded by the InterTAN. The ability to neutralize rotation and confer additional fracture stability emerges as the major advantage of the InterTAN design. The value of this study was demonstrated when stratified results revealed the high-functioning patient cohort consistently had better outcomes when treated with the InterTAN nail.
Femoral shortening commonly occurs in these fractures when treated with traditional cephalomedullary nails and is especially pronounced with SHS fixation. However, with less limb shortening documented, improved functional outcomes in this active geriatric group were demonstrated. The results of this specific InterTAN-treated cadre imply this implant provides significantly more stability to the unstable fracture pattern by preventing detrimental rotational moments and subsequent shortening. This is one of the first studies to highlight the relationship between length stability and hip fracture functional outcomes, and reveals the utility of this specific implant.