Comparison of Intramedullary Nails in the Treatment of Trochanteric and Subtrochanteric Fractures

Abstract

Background: Intramedullary nails are commonly used in the treatment of trochanteric and subtrochanteric fractures. We aimed to compare intramedullary nails in widespread use in Norway on the basis of reoperation risk. Methods: We assessed data from 13,232 trochanteric or subtrochanteric fractures treated with an intramedullary nail and registered in the Norwegian Hip Fracture Register between 2007 and 2019. The primary outcome measure was the risk of reoperation for various types of short and long intramedullary nails. Secondly, we compared risk of reoperation for the selected nails with respect to fracture type (AO/OTA type A1, A2, A3, and subtrochanteric fractures). Cox regression analysis adjusted for sex, age, and American Society of Anesthesiologists class was used to estimate hazard rate ratios (HRRs) for reoperation. Results: The mean patient age was 82.9 years, and 72.8% of the nails were used in the treatment of female patients. We included 8,283 short and 4,949 long nails. A1 fractures accounted for 29.8%, A2 for 40.6%, A3 for 7.2%, and subtrochanteric fractures for 22.4%. When comparing short nails regardless of fracture type, the TRIGEN INTERTAN had an increased risk of reoperation at 1 year (HRR, 1.31 [95% confidence interval (CI), 1.03 to 1.66]; p = 0.028) and 3 years (HRR, 1.31 [95% CI, 1.07 to 1.61]; p = 0.011) postoperatively compared with the Gamma3. For individual fracture types, we found no significant differences in reoperation risk between the various types of short nails. When comparing long nails, the TRIGEN TAN/FAN had an increased risk of reoperation at 1 year (HRR, 3.05 [95% CI, 2.10 to 4.42]; p < 0.001) and 3 years (HRR, 2.54 [95% CI, 1.82 to 3.54]; p < 0.001) postoperatively compared with the long Gamma3. Conclusions: This study may indicate a slightly increased risk of reoperation for the short TRIGEN INTERTAN compared with other short nails in widespread use in Norway. In analyses of long nails, the TRIGEN TAN/FAN nail was associated with a higher risk of reoperation in the treatment of trochanteric and subtrochanteric fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.