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Comparative Study
. 2025 Feb 19;107(4):389-396.
doi: 10.2106/JBJS.24.00404. Epub 2024 Dec 24.

Cephalomedullary Nailing for Subtrochanteric and Reverse-Oblique Femoral Fractures: Comparison of a Single Versus Dual Lag Screw Device

Andrew D Ablett  1 , Conor McCann  1 , Tony Feng  1 , Victoria Macaskill  2 , William M Oliver  1 , John F Keating  1   2
Affiliations
Comparative Study

Cephalomedullary Nailing for Subtrochanteric and Reverse-Oblique Femoral Fractures: Comparison of a Single Versus Dual Lag Screw Device

Andrew D Ablett et al. J Bone Joint Surg Am. .

Abstract

Background: Subtrochanteric proximal femoral fractures are generally treated with cephalomedullary nail fixation. We aimed to compare outcomes of subtrochanteric fracture fixation using a single lag screw (Gamma3 nail, GN) or dual lag screw (INTERTAN nail, IN) device.

Methods: The primary outcome measure was mechanical failure, defined as lag screw cut-out or back-out, nail breakage, or peri-implant fracture. Secondary outcomes included reoperation for mechanical failure, deep infection, or nonunion, and technical predictors of mechanical failure. Adult patients (≥18 years of age) with a subtrochanteric proximal femoral fracture treated at a single center were retrospectively identified using electronic records. All patients who underwent fixation using either a long GN (November 2010 to January 2017) or IN (March 2017 to April 2022) were included. Medical records and radiographs were reviewed to identify operative complications.

Results: A total of 587 patients were included: 336 in the GN group (median age, 82 years; 73% female) and 251 in the IN group (median age, 82 years; 71% female). The risk of mechanical failure was 3-fold higher in the GN group (adjusted hazard ratio [aHR], 2.87; p = 0.010), with screw cut-out (p = 0.04) and back-out (p = 0.04) only observed in the GN group. We observed a greater risk of reoperation for mechanical failure in the GN group, but this did not achieve significance (aHR, 2.02; p = 0.16). Independent predictors of mechanical failure included varus malalignment of >5° for cut-out (aHR, 17.43; p = 0.012), a tip-to-apex distance of >25 mm for back-out (aHR, 9.47; p = 0.019), and shortening of >1 cm for peri-implant fracture (aHR, 5.44; p = 0.001).

Conclusions: For older patients with subtrochanteric and reverse-oblique femoral fractures, the dual lag screw design of the IN nail was associated with a lower risk of mechanical failure compared with the single lag screw design of the GN nail.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I353 ).

References

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