Cephalomedullary Nailing for Subtrochanteric Femoral Shaft Fractures: A Comparison of Single Lag Screw With a Dual Lag Screw Device

Purpose: The aim of the current study was to compare outcomes of fixation of subtrochanteric fractures using a single lag screw device (Gamma nail, GN) with a dual lag screw device (Intertan nail, IN).

Methods: Patients treated in a single center with subtrochanteric femoral fractures were identified from hospital records. The initial cohort of patients had fixation with the GN device. The nailing system was changed during the study period and the second group in the study had fixation with the IN. Clinical notes and radiographs were reviewed to identify complications of fixation. These included any cut-outs, other modes of fixation failure, delayed union and nonunion, superficial and deep infection, and requirement for further surgery.

Results: There were 175 patients in the GN group and 171 in the IN group. The groups were well-matched demographically. Postoperative anemia requiring transfusion occurred in 51 GN patients (29%) and 36 IN patients (21%). Implant failures occurred more commonly in the GN group. Nail cut-out occurred in 4 (2.2%) of the GN but there were no cut-outs in the IN group (P <0.04). There were 5 periprosthetic fractures in the GN group and 2 in the IN group. Hip screws backed out in 4 GN cases and 2 nail breakages occurred. Implant-related failures therefore occurred in 15 (8.6%) of the GN group and only 2 (1.2%) of the IN group (P <0.001). Other complications including infection and nonunion did not differ between the 2 groups. Reoperations for complications or removal of implants was carried out in 12 (7%) GN and 9 (5%) of the IN group.

Conclusion: The results in this study suggest that that the dual lag screw design of the Intertan was associated with a lower risk of mechanical failure than the single lag screw of the Gamma nail for subtrochanteric femoral fractures. Other complications were observed to have an equal prevalence with both implants. Dual lag screw designs may reduce mechanical complications for these fractures. A prospective comparison of these fixation devices would be of value to confirm these findings.