Outcomes and associated factors after InterTAN nailing of geriatric intertrochanteric fractures

Large single-implant series of the dual integrated-screw InterTAN nail remain scarce. This study aimed to determine the rates of cut-out, reoperation, wound complication, and death after InterTAN nailing of intertrochanteric fractures in patients aged 65 years or older, and to identify the radiographic, morphological, and perioperative factors associated with each outcome.

We retrospectively reviewed 540 patients (543 hip fractures) aged 65 years or older treated with the InterTAN nail between 2021 and 2024 at a single center. Tip-apex distance (TAD) and collodiaphyseal angle (CDA) were measured by one observer. Vital status and dates of death came from national records, with follow-up censored on 30 July 2026. Firth penalized logistic regression and Cox regression were used.

The mean age was 80.2 years, and American Society of Anesthesiologists (ASA) class was 3 or higher in 79.6%. Cut-out occurred in 2.6%, wound complication in 2.2%, and reoperation in 3.7%. Mortality was 8.2% at 30 days and 33.1% at one year, with median survival of 34.2 months. Higher TAD and Evans-Jensen grade 4-5 were associated with cut-out and lower CDA with reoperation. Death was associated with age, ASA class, and preoperative delay (hazard ratio 1.05 per day, mean delay 8.0 days).

Cut-out was related to TAD and fracture pattern, reoperation to CDA, and death to age, ASA class, and preoperative delay. At a mean delay of 8 days, each additional day was associated with higher mortality, a finding consistent with operating as soon as the patient is medically fit.

IV (retrospective observational study).