Comparative study between InterTAN and Trochanteric femoral nailing (TFN) in Inter-trochanteric fractures: A prospective study of functional and radiological outcomes
Authors: Rajendraprasad Butala, Vinit Vimal Karn, Hardik Sahni
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Introduction: A prospective study was done in the Department of Orthopedics in Dr. D.Y. Patil Hospital, Navi Mumbai from January 2015 to March 2017 to Compare between Inter-Tan and trochanteric femoral nailing in Inter-trochanteric fractures and study functional and radiological outcomes.
Methods: All the patients attending OPD and emergency with inter trochanteric fracture without any sub trochanteric extension were admitted in our hospital and operated over a period of 2 year and 3 months. A total of 40 patients were included in our study of age group 40 to 70 years and divided in two groups (n1=20) and (n2=20). AO classification for fractures was used and 31-A1 and 31-A2 whereas 31-A3 variant was excluded from study. Patients were operated with two nailing systems i.e., n1= Inter-tan nailing system and n2=trochanteric nailing system. Follow-up assessments were performed at 2, 4, 6 weeks and every 6 months thereafter. Radiological assessment was done at each follow up and all associated implant position changes were also noted simultaneously. Functional outcomes were evaluated using Harris hip score.
Results: InterTAN had better outcomes in terms of varus collapse of the neck (InterTAN, n = 1 vs. TFN, n = 3), anterior thigh pain (InterTAN, n = 1 vs. TFN, n = 4), femoral neck shortening (InterTAN, 4.2 mm vs. TFN, 5.4 mm), fracture healing time (InterTAN, 13 weeks vs. TFN, 15 weeks), femoral shaft fractures (InterTAN, n = 0 vs. TFN, n = 1), screw back out (InterTAN, n = 0 vs. TFN, n = 3), lateral cortex fractures of the proximal femur (InterTAN, n = 3 vs. TFN, n = 2), operative time (InterTAN-65 min vs. TFN-50 min), fluoroscopy time (InterTAN, 4.0 min vs. TFN, 3 min), hospital stay (InterTAN, 7 days vs. TFN, 7 days), cut-out (InterTAN, n = 0 vs. TFN, n = 3). Harris Hip score (InterTAN-82, TFN 78).
Conclusion: The results of our study shows that the incidence of varus collapse of the head/neck, hip and anterior thigh pain, implant cut-outs, and femoral neck shortening and femoral shaft fractures at distal tip of implant, rotational loss of reduction were comparatively less in InterTAN subjects comparing with TFN subjects. The time for surgical procedure and fluoroscopy time was more as compared to TFN which can be reduced if procedure is done more frequently. Better radiological and functional outcomes with less degree of complications makes InterTAN a better option for fixation of Intertrochanteric fractures.