Research Article| Volume 41, ISSUE 12, P1292-1296, December 2010

Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip—Blade vs screw


      With industrial societies getting older the incidence of femoral fractures is increasing. Complication rates up to 20% have led to a continuous improvement of intramedullar nailing systems and the third generation of implants is in clinical application. They seem superior to the second generation. But as clinical data is still fragmentary, we wanted to compare a second generation implant, the Proximal Femur Nail with three devices of the third generation: the Gleitnagel, Trochanter Fixation Nail and the Proximal Femur Nail Antirotation with a clinical study. We analysed whether fracture reduction and implant position could possibly be indicators for implant complications.
      Patients with a trochanteric fracture type A1–A3 (AO/ASIF classification) admitted at the department of traumatology Augsburg were enrolled. Postoperative X-rays were analysed in the matter of fracture reduction for the fracture gap, the Garden Alignment Index and for the matter of implant position in the femur head with the cleaveland zones and the Tip Apex Distance.
      322 patients were enrolled. Most frequent was the A2 (n = 240) and the A3 type of fracture (n = 80) followed by A1 (n = 29). Time to hospital discharge was 17 days (9/25), 12 patients died (3.2%). The complication rate (cutting out) in the third generation was lower (2.5–7%) than in the second generation (14%). The postoperative range of mobilisation compared to the old social status was in the groups with 34% similar after 3 months.
      The third generation nails are safe and reliable implants. Compared with second generation devices, fewer complications are observed. A correlation might be seen in the postoperative X-rays between the fracture reduction or implant position and implant related mechanical complications (cutting out).


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baumgaertner M.R.
        • Curtin S.L.
        • Lindskog D.M.
        Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.
        Clin Orthop Relat Res. 1998; : 87-94
        • Baumgaertner M.R.
        • Curtin S.L.
        • Lindskog D.M.
        • Keggi J.M.
        The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.
        J Bone Joint Surg Am. 1995; 77: 1058-1064
        • Blair B.
        • Koval K.J.
        • Kummer F.
        • Zuckerman J.D.
        Basicervical fractures of the proximal femur. A biomechanical study of 3 internal fixation techniques.
        Clin Orthop Relat Res. 1994; : 256-263
        • Bonnaire F.
        • Zenker H.
        • Lill C.
        • et al.
        Treatment strategies for proximal femur fractures in osteoporotic patients.
        Osteoporos Int. 2005; 16: S93-S102
        • Cleveland M.
        • Bosworth D.M.
        • Thompson F.R.
        • et al.
        A ten-year analysis of intertrochanteric fractures of the femur.
        J Bone Joint Surg Am. 1959; 41-A: 1399-1408
        • Friedl W.
        • Anthoni C.
        • Fritz T.
        • et al.
        Importance of blade geometry for stability of fixation with short intramedullary nailing systems for the proximal end of the femur (gliding nail).
        Langenbecks Arch Chir Suppl Kongressbd. 1998; 115: 1224-1226
        • Geiger F.
        • Zimmermann-Stenzel M.
        • Heisel C.
        • et al.
        Trochanteric fractures in the elderly: the influence of primary hip arthroplasty on 1-year mortality.
        Arch Orthop Trauma Surg. 2007; 127: 959-966
        • Geller J.A.
        • Saifi C.
        • Morrison T.A.
        • Macaulay W.
        Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures.
        Int Orthop. 2009;
        • Handoll H.H.
        • Parker M.J.
        • Sherrington C.
        Mobilisation strategies after hip fracture surgery in adults.
        Cochrane Database Syst Rev. 2003; : CD001704
        • Hesse B.
        • Gachter A.
        Complications following the treatment of trochanteric fractures with the gamma nail.
        Arch Orthop Trauma Surg. 2004; 124: 692-698
        • Hohendorff B.
        • Meyer P.
        • Menezes D.
        • et al.
        Treatment results and complications after PFN osteosynthesis.
        Unfallchirurg. 2005; 108 (940, 941–938, 940, 946): 938
        • Johansson T.
        • Jacobsson S.A.
        • Ivarsson I.
        • et al.
        Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips.
        Acta Orthop Scand. 2000; 71: 597-602
        • Johnell O.
        • Kanis J.A.
        An estimate of the worldwide prevalence, mortality and disability associated with hip fracture.
        Osteoporos Int. 2004; 15: 897-902
        • Lenich A.
        • Mayr E.
        • Ruter A.
        Hip replacement after failed internal fixation in patients with proximal femur fracture--a simple procedure?.
        Zentralbl Chir. 2002; 127: 503-506
        • Lenich A.
        • Mayr E.
        • Ruter A.
        • et al.
        First results with the trochanter fixation nail (TFN): a report on 120 cases.
        Arch Orthop Trauma Surg. 2006; 126: 706-712
        • Lorich D.G.
        • Geller D.S.
        • Nielson J.H.
        Osteoporotic pertrochanteric hip fractures: management and current controversies.
        Instr Course Lect. 2004; 53: 441-454
        • Osterkamp R.
        Population developments in Germany until 2050.
        Chirurg. 2005; 76: 10-18
        • Parker M.J.
        • Handoll H.H.
        Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults.
        Cochrane Database Syst Rev. 2008; (CD000093)
        • Petersen M.B.
        • Jorgensen H.L.
        • Hansen K.
        • Duus B.R.
        Factors affecting postoperative mortality of patients with displaced femoral neck fracture.
        Injury. 2006; 37: 705-711
        • Robinson C.M.
        • Adams C.I.
        • Craig M.
        • et al.
        Implant-related fractures of the femur following hip fracture surgery.
        J Bone Joint Surg Am. 2002; 84-A: 1116-1122
        • Schipper I.B.
        • Marti R.K.
        • van der W.C.
        Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of literature.
        Injury. 2004; 35: 142-151
        • Schurch M.A.
        • Rizzoli R.
        • Mermillod B.
        • et al.
        A prospective study on socioeconomic aspects of fracture of the proximal femur.
        J Bone Miner Res. 1996; 11: 1935-1942
        • Simmermacher R.K.
        • Ljungqvist J.
        • Bail H.
        • et al.
        The new proximal femoral nail antirotation (PFN A) in daily practice: results of a multicentre clinical study.
        Injury. 2008; 39: 932-939
        • Smektala R.
        • Ohmann C.
        • Paech S.
        • et al.
        On the prognosis of hip fractures. Assessment of mortality after hip fractures by analyzing overlapping segments of longitudinal data.
        Unfallchirurg. 2005; 108: 927-937
        • Werner-Tutschku W.
        • Lajtai G.
        • Schmiedhuber G.
        • et al.
        Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN.
        Unfallchirurg. 2002; 105: 881-885