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TRIGEN INTERTAN Intramedullary Nail Versus Sliding Hip ScrewA Prospective, Randomized Multicenter Study on Pain, Function, and Complications in 684 Patients with an Intertrochanteric or Subtrochanteric Fracture and One Year of Follow-up
Kjell Matre, MD1; Tarjei Vinje, MD1; Leif Ivar Havelin, MD, PhD1; Jan-Erik Gjertsen, MD, PhD1; Ove Furnes, MD, PhD1; Birgitte Espehaug, MSc, PhD1; Stein-Harald Kjellevold, MD2; Jonas Meling Fevang, MD, PhD1
1 Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N-5021 Bergen, Norway. E-mail address for K. Matre: kjell.matre@helse-bergen.no. E-mail address for T. Vinje: tarjei.vinje@helse-bergen.no. E-mail address for L.I. Havelin: leif.havelin@helse-bergen.no. E-mail address for J.-E. Gjertsen: jan-erik.gjertsen@helse-bergen.no. E-mail address for O. Furnes: ove.furnes@helse-bergen.no. E-mail address for B. Espehaug: birgitte.espehaug@helse-bergen.no. E-mail address for J.M. Fevang: jonas.meling.fevang@helse-bergen.no
2 Department of Radiology, Haraldsplass Deaconess Hospital, Ulriksdal 8, N-5009 Bergen, Norway. E-mail address: stein-harald.kjellevold@haraldsplass.no
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Investigation performed at the Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, and the Department of Surgical Sciences, University of Bergen, Bergen, Norway

A commentary by Hans J. Kreder, MD, FRCSC, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Feb 06;95(3):200-208. doi: 10.2106/JBJS.K.01497
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Abstract

Background: 

Both intramedullary nails and sliding hip screws are used with good results in the treatment of intertrochanteric and subtrochanteric fractures. The aim of our study was to assess whether use of the TRIGEN INTERTAN nail, as compared with a sliding hip screw, resulted in less postoperative pain, improved functional mobility, and reduced surgical complication rates for patients with an intertrochanteric or subtrochanteric fracture.

Methods: 

In a prospective, randomized multicenter study, 684 elderly patients were treated with the INTERTAN nail or with a sliding hip screw with or without a trochanteric stabilizing plate. The patients were assessed during their hospital stay and at three and twelve months postoperatively. A visual analogue scale (VAS) pain score was recorded at all time points, and functional mobility was assessed with use of the timed Up & Go test. The Harris hip score (HHS) was used to assess hip function more specifically. Quality of life was measured with the EuroQol-5D (EQ-5D). Radiographic findings as well as intraoperative and postoperative complications were recorded and analyzed.

Results: 

Patients treated with an INTERTAN nail had slightly less pain at the time of early postoperative mobilization (VAS score, 48 versus 52; p = 0.042), although this did not influence the length of the hospital stay and there was no difference at three or twelve months. Regardless of the fracture and implant type, functional mobility, hip function, patient satisfaction, and quality-of-life assessments were comparable between the groups at three and twelve months. The numbers of patients with surgical complications were similar for the two groups (twenty-nine in the sliding-hip-screw group and thirty-two in the INTERTAN group, p = 0.67).

Conclusions: 

INTERTAN nails and sliding hip screws are similar in terms of pain, function, and reoperation rates twelve months after treatment of intertrochanteric and subtrochanteric fractures.

Level of Evidence: 

Therapeutic Level I. See Instruction for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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