Key Takeaways & Executive Findings
- •• PFNA demonstrated significantly shorter operation time, less blood loss, and fewer fluoroscopy exposures compared to InterTAN, indicating lower perioperative trauma. • At 12 months postoperatively, InterTAN showed significantly lower rates of internal fixation instability and better Harris hip scores for pain, function, and range of motion. • Fracture healing rates and overall complication rates were comparable between the two fixation systems. • The choice between PFNA and InterTAN should be individualized based on patient comorbidities and fracture stability, balancing perioperative risks and long-term functional outcomes.
Abstract
BACKGROUND: Elderly patients with intertrochanteric fractures often have multiple medical comorbidities and significant osteoporosis, posing considerable challenges for treatment. Proximal femoral nail anti-rotation (PFNA) and InterTAN are both commonly used intramedullary fixation systems. However, there remains insufficient evidence regarding the optimal selection of fixation systems for patients with different medical conditions and fracture types. OBJECTIVE: To compare the clinical outcomes and complication differences between InterTAN and PFNA in the treatment of elderly patients with intertrochanteric fractures. METHODS: A prospective randomized controlled trial was conducted. A total of 118 elderly patients with intertrochanteric fractures who met the inclusion criteria were enrolled. Patients were randomly divided into two groups: PFNA group (59 cases) underwent internal fixation with PFNA, and InterTAN group (59 cases) underwent internal fixation with InterTAN. Perioperative parameters, including operation time, intraoperative blood loss, fluoroscopy frequency, and hospital stay, were recorded. Follow-up assessments were conducted at 1, 3, 6, and 12 months postoperatively. The fracture healing rate, internal fixation stability, and complications were evaluated using Harris hip scores and imaging examinations. RESULTS AND CONCLUSION: (1) The PFNA group had significantly shorter operation time, less intraoperative blood loss, and fewer fluoroscopy exposures than the InterTAN group (P < 0.001), while hospital stay showed no significant difference (P > 0.05). (2) At 12 months postoperatively, the fracture healing rate was similar between the two groups (P > 0.05). However, the InterTAN group had a significantly lower rate of internal fixation instability (P < 0.05) and better Harris pain, function, and range of motion scores (P < 0.05). The overall complication rate did not differ significantly between groups (P > 0.05). (3) These findings suggest that PFNA offers advantages in perioperative trauma, while InterTAN shows potential benefits in fixation stability and functional recovery at 1-year follow-up. The choice of internal fixation system should be tailored to the patient's condition and fracture type.
1. Introduction
Elderly intertrochanteric fractures are common severe traumatic injuries, with incidence rising as the population ages. These patients often have osteoporosis and multiple medical comorbidities, increasing surgical difficulty and postoperative complications and mortality. Intramedullary nailing has become the primary treatment due to its favorable biomechanical properties and minimally invasive advantages. However, the optimal choice of intramedullary nail system remains debated.
Currently, the proximal femoral nail anti-rotation (PFNA) and the integrated compression screw and lag screw intertrochanteric nail (InterTAN) are widely used. PFNA is favored for its simplicity and shorter operative time, but its long-term stability in unstable fractures is controversial. InterTAN, with its dual-screw design, theoretically provides better rotational and axial stability, but it is more complex and may cause greater perioperative trauma. Systematic comparisons of these systems, especially regarding functional recovery and complications, are lacking. This prospective randomized controlled trial aims to compare the clinical efficacy and complications of PFNA and InterTAN in elderly patients with intertrochanteric fractures, providing evidence for clinical decision-making.
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He Yun, Yiliyaer·Abudusimu, Xu Bin, Wang Guosheng (2026). InterTAN versus proximal femoral nail anti-rotation for intertrochanteric fractures in the elderly: a comparison of joint function and stability. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21401
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Frequently Asked Questions
What are the main differences between PFNA and InterTAN in treating elderly intertrochanteric fractures?
PFNA is associated with shorter operative time, less blood loss, and fewer fluoroscopy exposures, indicating lower perioperative trauma. InterTAN, on the other hand, provides better fixation stability and functional recovery at 12 months postoperatively, as evidenced by lower instability rates and higher Harris hip scores.
Which fixation system has a lower complication rate?
The overall complication rates were similar between PFNA and InterTAN groups in this study. However, InterTAN showed a lower rate of fixation-related complications, possibly due to its dual-screw design providing stronger stability and reducing risks of screw loosening or cut-out.
How does the choice of implant affect functional recovery?
At 12 months postoperatively, patients treated with InterTAN had significantly better Harris pain, function, and range of motion scores compared to those treated with PFNA, suggesting that InterTAN may offer superior functional outcomes in the long term.
What factors should be considered when selecting between PFNA and InterTAN?
The choice should be individualized based on the patient's overall health, fracture stability, and surgeon's expertise. PFNA may be preferred for patients with higher surgical risk due to its less invasive nature, while InterTAN may be beneficial for unstable fractures where long-term stability is crucial.
Are there any significant differences in fracture healing rates between the two implants?
No significant difference in fracture healing rates was observed between PFNA and InterTAN groups at 12 months postoperatively, indicating both implants are effective in achieving bone union.
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