Clinical and functional outcomes of internal fixation with intertrochanteric antegrade nail in older patients with proximal extracapsular femoral fractures.

Abstract

The intertrochanteric Trigen Intertan(®) nail (Smith & Nephew, Memphis, TN) is a popular fixation device for proximal extracapsular femoral fractures (PEFFs). We evaluated clinical and functional outcomes in patients with PEFFs treated with Trigen Intertan(®) nail. In a single-site, prospective observational study, clinical and functional parameters were recorded for all patients admitted to the Emergency Department with PEFFs from June 2008 through June 2011. Patients with severe cognitive impairment, severe disability, neoplastic pathological fractures, or suffering from terminal illnesses were not eligible for the study. Fractures were classified according to the AO/OTA classification system. Preoperative physical fitness was assessed via the American Association of Anaesthetists (ASA) score. The Barthel index was used to quantify the level of physical function before fracture and at follow-up. One-hundred thirty-five patients with PEFFs were eligible for inclusion during the 3-year survey (mean age 83.2±9.5years; 82% females). Fracture type distribution was as follows: A1.1=18%, A1.2=7%, A1.3=5%, A2.1=44%, A2.2=21%, A2.3=5%. All patients were treated with Trigen Intertan(®) nail. Two patients experienced a fracture of the femoral shaft during the insertion of a long nail for an A2.3 fracture. Weight-bearing was allowed between the third and tenth postoperative day depending on pain tolerance and general conditions. No loss of reduction, collapse of the femoral neck, nonunion or fixation failure were observed. Two patients died within 10days postoperatively, and nine within 6months after surgery. Functional status 1month after surgery was lower than pre-fractural levels, and improved over follow-up. At 6months, functional status was comparable to the pre-fractural level. Trigen Intertan(®) produces highly satisfactory clinical and functional results in older patients with PEFFs. Complete functional recovery is obtained on average 6months after surgery.