The benefit of using a long intramedullary device for the treatment of geriatric intertrochanteric hip fractures is unknown. The InterTAN device (Smith and Nephew, Memphis TN) is offered in either Short (180–200 mm) or Long (260–460 mm) constructs and was designed to provide stable compression across primary intertrochanteric fracture fragments. The objective of our study was to determine whether Short InterTANs are equivalent to Long InterTANs in terms of functional and adverse outcomes for the treatment of geriatric intertrochanteric hip fractures. 108 patients with OTA classification 31A–1 and 31A–2 intertrochanteric hip fractures were included in our study and prospectively followed at one of four Canadian Level-1 Trauma Centres. Our primary outcomes included two validated primary outcome measures: the Functional Independence Measure (FIM), to measure function, and the Timed Up and Go (TUG), to measure motor performance. Secondary outcome measures included blood loss, length of procedure, length of stay and adverse events. A pre-injury FIM was measured by retrospective recall and all postoperative outcomes were assessed on postoperative day 3, at discharge, at 6 weeks, 3 months, 6 months and 12 months postoperatively. Unpaired t-tests and Chi-square tests were used for the comparison of continuous and categorical variables respectively between the Short and Long InterTAN groups. A statistically significant difference was defined as p<0.05. Our study included 71 Short InterTAN and 37 Long InterTAN patients with 31A–1 and 31A–2 intertrochanteric hip fractures. Age, sex, BMI, side, living status and comorbidities were similar between the two groups. The mean operative time was significantly lower in the Short InterTAN group (61 mins) as compared to the Long InterTAN group (71 mins)(p0.05). There were 5 periprosthetic femur fractures in the short InterTAN group versus 1 in the long InterTAN group. Non-mechanical adverse outcomes such as myocardial infarction, pulmonary embolism, urinary tract infections, pneumonia and death all had similar incidence rates between the two InterTAN groups. Both the Short and Long InterTAN patient cohorts displayed similar improvements in performance and overall function over the course of a year following intertrochanteric hip fracture fixation. The recorded operative times for Short InterTAN fixation were significantly shorter than those recorded for the Long InterTAN patients. Alternatively, a significantly higher proportion of Short InterTAN patients sustained periprosthetic femur fractures within a year of implantation as compared to the Long InterTAN group.
This study was designed to answer the question “Is there a difference in outcome following operative management of AO type C distal humerus fractures for patients with associated injuries compared to those with isolated injuries?” Our hypothesis was that patients with associated injuries would have worse outcomes compared to those with isolated injuries. Fifty-eight patients with fifty-eight fractures managed with ORIF were included. Hospital records, clinic notes and radiographs of these patients were retrospectively reviewed. MFA and DASH scores were prospectively obtained after patients were identified (mean 37.4 months post injury, range 6–74 months). Thirty-two patients had isolated distal humeral fractures while twenty-six patients had distal humeral fractures with associated injuries. The mean MFA of patients with isolated injuries was significantly lower than for patients with associated injuries (27.2 vs 41.7, p = 0.01). There was no difference in DASH scores between the two groups (23.7 vs 29.1, p = 0.34). The mean postoperative arc of motion was one hundred and seven degrees for isolated injuries and seventy-five degrees for patients with associated injuries (p=0.006). Surgical release for stiffness was required for two patients (6%) in the isolated group and ten patients (38%) in the associated injuries group (p=0.003). Outcomes for isolated distal humeral fractures in this study were comparable to previously published literature. Patients who sustain associated injuries at the time of distal humeral fracture have more stiffness and a worse outcome on a global outcome score, but a similar outcome on a limb specific outcome score.
