Association Between Nail Type and Aseptic Revision Risk After Cephalomedullary Nailing for Hip Fracture

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Clinical outcomes research

Background:

• Cephalomedullary nailing is standard for intertrochanteric femoral fractures.
• Clinical performance variations among nail types are not well-established.
• This study compares three common cephalomedullary nails: Gamma, INTERTAN, and TFN/TFNA.

Purpose of the Study:

• To compare aseptic revision rates of three commonly used cephalomedullary nails.
• To evaluate the clinical performance of Gamma, INTERTAN, and TFN/TFNA implants in hip fracture treatment.

Main Methods:

• Retrospective analysis of a hip fracture registry (n=19,215) for patients aged ≥60.
• Multivariable Cox proportional-hazards regression controlled for confounders.
• Aseptic revision was the primary outcome, with mortality as a competing event.

Main Results:

• The INTERTAN nail group had a significantly higher risk of aseptic revision compared to the TFN/TFNA group (HR 1.62, p=0.006).
• This increased risk was primarily associated with long INTERTAN nails.
• No significant difference in aseptic revision rates was observed between the Gamma nail and TFN/TFNA groups.

Conclusions:

• The INTERTAN nail demonstrated a higher risk of aseptic revision in hip fracture patients.
• Further investigation into the INTERTAN nail's unique design may explain the observed differences.
• These findings have implications for implant selection in intertrochanteric fracture management.