Long Versus Short Twin-Screw Integrated Cephalomedullary Nail (InterTAN) for the Surgical Management of Intertrochanteric Fractures of the Hip in Indians

Introduction: With an increasing life expectancy, there has been an increase in the incidence of intertrochanteric fractures. These fractures in the elderly are disabling and have a tremendous impact on the healthcare system. Despite substantial improvements in implant design and surgical techniques, high failure rates have been observed, varying with the severity of the fracture and the type of fixation. Intramedullary nails have become popular in recent times, especially in unstable fractures. The purpose of the present study is to compare the functional outcomes and complications of long versus short InterTAN cephalomedullary nails (Smith & Nephew, Memphis, Tennessee) used for intertrochanteric fracture fixation. Materials and methods: All patients who had intertrochanteric fractures classifiable as AO OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association) 31-A and were treated with either a short InterTAN nail (SIN) or long InterTAN nail (LIN) between March 2017 and March 2020 were retrospectively assessed. AO subtype A1 fractures are considered to be stable whereas subtype A3 fractures are considered unstable. The stability of subtype A2 fractures is variable depending on the amount of posteromedial comminution. Both stable and unstable fractures were included. Patients aged above 18 years, who had a normal pre-injury gait and were operated on within seven days of trauma as per the records were included in the study. Postoperatively, functional outcome recorded using the modified Harris hip score (mHHS) was compared. The minimum follow-up period was 24 months. Results: A total of 89 patients fulfilling the inclusion criteria were included. The mean age was 67.5 ± 8.92 years. Of the patients, 72% were above 60 years of age and 68% of those were females. The mean follow-up period was 31 months (range: 24-54 months). Of the patients, 84.27% sustained fractures after a trivial trauma due to slip and fall at home. All fractures had united at nine to 12 months, except one had a screw cut-out, which required revision surgery. The mean mHHS at three months and nine to 12 months postoperatively was 42.46 ± 3.62 and 87.24 ± 6.44, respectively. The patients who were treated with LIN had a significantly better functional outcome at three-month follow-up (p-value < 0.05); however, post one year, this effect plateaued and no significant difference was seen when comparing SIN with LIN. The results also showed that there was no significant difference in complications among SIN and LIN. Conclusion: Both LIN and SIN are equally effective for the surgical management of intertrochanteric fractures, and have similar functional outcomes. SIN, however, has shorter surgical procedure time and lesser estimated blood loss. LIN allowed in early recovery evidenced by better Harris hip scores at three months duration, thus improving the quality of life in the initial months post surgery. The choice of implant should be individualized according to fracture anatomy, patients’ needs and expectations, and surgeons’ expertise.