Are Two-Part Intertrochanteric Femur Fractures Stable and Does Stability Depend on Fixation Method?

Area of Science:

• Orthopaedic surgery
• Trauma surgery
• Biomechanics

Background:

• Two-part intertrochanteric femur fractures are common in elderly patients.
• Fixation method significantly impacts fracture stability and outcomes.
• Secondary collapse is a concern following fixation of these fractures.

Purpose of the Study:

• To evaluate the stability of 2-part intertrochanteric femur fractures.
• To determine if secondary collapse is associated with the chosen fixation method.

Main Methods:

• Retrospective cohort study of 114 patients over 50 years old with 2-part intertrochanteric femur fractures.
• Patients were treated with either a sliding hip screw (DHS), dual screw trochanteric entry nail (INTERTAN), or single-blade intramedullary nail (TFN).
• Fracture collapse was measured by comparing immediate postoperative and final follow-up radiographs.

Main Results:

• Average collapse was 6.8 mm (DHS), 3.7 mm (INTERTAN), and 7.3 mm (TFN).
• Significantly more collapse occurred with DHS (P=0.021) and TFN (P<0.001) compared to INTERTAN.
• 26% of DHS and 26% of TFN patients experienced >10 mm collapse, versus 8% for INTERTAN.

Conclusions:

• Fracture fixation device choice influences the stability of 2-part intertrochanteric femur fractures.
• Sliding hip screw fixation is associated with substantial collapse in a significant percentage of patients.
• Dual screw intramedullary nailing (INTERTAN) demonstrated the most effective stability and least collapse for this fracture pattern.