Five-Year Outcome Analysis of Intertrochanteric Femur Fractures: A Prospective Randomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail

OBJECTIVES: To compare the radiological and functional outcome after fixation of intertrochanteric fractures (IF) using either an integrated two-screw cephalomedullary nail (InterTan (IT), Smith&Nephew, Memphis, Tn, USA) or a single-screw device (Gamma3 (G3), Stryker, Kalamazoo, Mi, USA) with a 5-years follow-up.

DESIGN: Prospective, randomized SETTINGS:: A single center study PATIENTS:: 104 patients with a mean age of 81.2±9.2 years were included, 33 patients were available for the final 5 year follow-up, 63 patients died and 8 patients were lost for follow-up.

INTERVENTION: Internal fixation of intertrochaneteric femur fractures using a cephalomedullary nail with either a single screw or an integrated two-screw system MAIN OUTCOME MEASUREMENTS:: Length of hospital stay, SF-36-questionnaire, Harris-Hip-Score, radiographs.

RESULTS: SF-36 index at 6 months indicated that 93% of the IT-group returned to their prefracture status compared to only 80% in the G3-group. For the mental health SF-36 index the IT patients showed a significant increased level six months after the index procedure (IT: p=0.02; G3: p=0.20). The length of hospital stay was significantly (p=0.03) shorter in the IT-group. After 5 years however, neither group had significant implant related complications or differences in terms of functional outcome.

CONCLUSIONS: Regarding functional outcome and hospital stay the IT collective performed better in the 6 month follow up. After 5 years no significant differences were recorded.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.