Comparison of clinical and radiological outcomes in intertrochanteric fractures treated with InterTAN nail against conventional cephalomedullary nails: a systematic review

Intertrochanteric fractures, accountable for 50% of hip fractures, can be fixed with cephalomedullary devices such as Proximal Femoral Nail Antirotation (PFNA (TM)), Gamma3 nailing system and TRIGEN (TM) InterTAN (TM) nail (IT). IT uniquely uses two cephalocervical screws that allow for linear compression and provide additional resistance to femoral head rotation. A literature review assessing clinical outcomes of these devices was conducted, with 14 studies enrolling 3104 patients meeting the inclusion criteria. PFNA and Gamma3 had better intraoperative outcomes compared with IT; however, IT had superior implant-related outcomes of cut-out and screw migration. No difference was found between IT and PFNA or Gamma3 in Harris Hip Scores, time to union, malunion and nonunion. Further long-term studies are needed to evaluate clinical outcomes and cost-effectiveness of cephalomedullary devices. Lay abstract Hip fractures remain a significant cause of morbidity and mortality within healthcare systems, with an estimated global incidence of 1.6 million fractures annually. Certain intertrochanteric fractures - a specific subtype of hip fractures - are treated surgically using intramedullary nailing devices such as Proximal Femoral Nail Antirotation (PFNA (TM)), Gamma3 nailing system and InterTAN (TM) nail (IT). IT is unique, in that it uses two proximal screws. This study assessed the clinical and radiological outcomes of using IT over the traditional one-screw devices PFNA and Gamma3.