Prospective Analysis of Asian Type 2 Integrated Lag Screws (Hip Fracture Nail) in Patients with Intertrochanteric Fractures.

Abstract

Background: The Hip Fracture Nail (HFN), developed by modifying the design and diameter of the INTERTAN nail, has been introduced to the market. The purpose of our study was to evaluate the clinical and radiological outcomes, as well as the perioperative complications, associated with the use of the HFN in Asian patients with intertrochanteric fractures.

Methods: Patients over the age of 60 years with intertrochanteric fractures were prospectively enrolled at 6 university hospitals in South Korea and underwent surgical treatment using the HFN between October 2018 and January 2022. Patients who died or were lost to follow-up within 1 year were excluded from the analysis. Intraoperative surgical records related to the HFN, along with postoperative clinical and radiological data, were prospectively collected. Intraoperative and postoperative complications were recorded during the 1-year follow-up after surgery.

Results: Of the 320 patients, 159 patients were followed up for at least 1 year. The mean follow-up period was 17 ± 3 months. A total of 111 patients (70%) recovered their pre-fracture status. The mean time to bony union was 10.2 weeks. Reduction quality was acceptable or good in 99% of patients. Superior positioning of the lag screws in the femoral head occurred in only 2 cases. Difficulty in targeting the distal interlocking screw hole during the operation occurred in 4 cases (2.6%), with 2 of these patients developing periprosthetic fractures at distal interlocking screw holes. Postoperative complications requiring reoperation occurred in 5 patients (3.1%). Two cases of cut-out accompanied by nonunion underwent replacement arthroplasty (nonunion rate, 1.3%). Three cases of periprosthetic fractures at the distal static screw hole underwent refixation with a longer intramedullary nail. The remaining postoperative complications, including collapse at the fracture site in 5 cases (3.1%), the lateral wall fractures in 1 case (0.6%), and malunion in 1 case (0.6%), did not require surgical intervention.

Conclusions: This study demonstrated that the HFN provided good clinical and radiological outcomes in Asian patients with intertrochanteric fractures. However, difficulty in targeting the distal interlocking screw hole may occur with low probability, requiring caution during surgery.