Intertrochanteric fractures: comparison between two different locking nails

Purpose The aim of this study was to compare two intramedullary devices used in the treatment of intertrochanteric fractures. Method During the period 2006–2007 46 TGN and 51 PFNA were used for the treatment of intertrochanteric fractures in our hospital. Clinical and radiological follow-up were available. Surgical time, blood loss and complications have been considered. Results The mean operative time for the TGN group was significantly higher than in the PFNA group (62 min and 45 min, respectively) with a p00.04. The mean blood loss was significantly higher in the TGN group (285 ml; SD 145) in relation to the PFNA group (226 ml; SD 136) with p0 0.03. Also, rate of complications was higher in the TGN group (p00.01). Clinical outcomes were good for both groups. Intra-operative and post-operative complications in the TGN group were associated with a longer operative time and a higher blood loss, probably due to the reaming needed in TGN that can increase blood loss and risk of comminution or fracture propagation. Moreover, all but one of the procedure-related complications were observed in very elderly patients. Conclusions Based on our results in the intertrochanteric fracture, use of PFNA should be recommended in cases of elderly and osteoporotic patients, while TGN should be used in more severely displaced fractures in patients with a slightly better bone mineral density.