TY - JOUR
T1 - Cephalomedullary nail fixation of intertrochanteric femur fractures
T2 - Are two proximal screws better than one?
AU - Serrano, Rafael
AU - Blair, James A.
AU - Watson, David T.
AU - Infante, Anthony F.
AU - Shah, Anjan R.
AU - Mir, Hassan R.
AU - Maxson, Benjamin J.
AU - Downes, Katheryne W.
AU - Sanders, Roy W.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Objectives: 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. Design: Retrospective comparative study. Setting: Level 1 regional trauma center. Patients: 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). Intervention: Cephalomedullary nail insertion. Outcome Measures: 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. Results: 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). Conclusions: 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.
AB - Objectives: 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. Design: Retrospective comparative study. Setting: Level 1 regional trauma center. Patients: 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). Intervention: Cephalomedullary nail insertion. Outcome Measures: 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. Results: 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). Conclusions: 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.
KW - Cephalomedullary nail
KW - Dual screw fixation
KW - Femoral neck shortening
KW - Gamma 3
KW - InterTAN
KW - Intertrochanteric femur fractures
KW - Unstable femur fractures
KW - Varus collapse
UR - http://www.scopus.com/inward/record.url?scp=85032037897&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032037897&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000000967
DO - 10.1097/BOT.0000000000000967
M3 - Article
C2 - 28827501
AN - SCOPUS:85032037897
SN - 0890-5339
VL - 31
SP - 577
EP - 582
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
IS - 11
ER -