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TRIGEN INTERTAN

Intertrochanteric Antegrade Nail

Product Information


There are several challenges with conventional hip fracture implants:


1. Varus collapse

2. Femoral neck shortening

3. Shaft fractures below the tip of the nail

Download Surgical Technique

How is the TRIGEN INTERTAN Intertrochanteric Antegrade Nail different?

Improved Patient Outcomes 1
• 0 incidence of neck malunion, non-union, uncontrolled collapse or Z-effect at one year
• 0 patients had shortening in 73% of cases (only 27% of cases had mild shortening, <5mm)>
• 90% of patients recovered their pre-fracture functional status according to the Barthel Index and
• 58% recovered according to the Harris Hip Score



Features
• Integrated interlocking screw configuration
• Trapezoidal shape in the proximal femur for a press-fit
• Clothes pin distal tip on the short nails

Benefits
• Improved patient outcomes
• Fracture stability
• Active linear compression
• Rotational control


For more information, please contact your local sales representative.

References
1. Rueger J, Moore C. Shortening of the femoral neck following peritrochanteric fracture. Bone&Joint Science ( www.KLEOS.md) 2011; 2(5).

Clinical Evidence


Papers

Shortening of the Femoral Neck Following Peritrochanteric Fracture
Rueger J, Moore C. Shortening of the femoral neck following peritrochanteric fracture. Bone&Joint Science ( www.KLEOS.md) 2011; 2(5).
“… the newly developed INTERTAN intertrochanteric antegrade nail improves rotational fracture stability and allows for intraoperative interfragmentary compression, thereby reducing the erosion of the fracture surfaces between the lateral end of the neck fragment and the trochanteric region that might result in uncontrolled collapse with the risk of shortening.”
The Treatment of Intertrochanteric Fractures: Results Using an Intramedullary Nail With Integrated Cephalocervical Screws and Linear Compression
Ruecker, Andreas H; Rupprecht, M; Gruber, M; Gebauer, M; Barvencik, F; Briem, D; Rueger, J M
Journal of Orthopaedic Trauma, January 2009,23(1):22-30
“Objective: A new device for the treatment of intertrochanteric fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intraoperative compression and rotational stability of the head/neck fragment has been developed. The aim of this study was to describe the results using this device for the treatment of stable and unstable intertrochanteric fractures.”
TRIGEN INTERTAN Cycle Testing
The TRIGEN INTERTAN nail was compared to single lag screw and helical blade devices in a Sommers cut out test protocol of 100,000 cycles. The TRIGEN INTERTAN device was superior to the other devices and had no incidence of cut out.
Evaluation of Cyclic Cut-Out Failure in Intramedullary Nails: A Comparison of Single Lag Screws and Integrated Interlocking Screws
Written by: TA Russell, SA Summy and SA Whitten all of Campbell Clinic
“The purpose of this research is to compare cutout of this new screw configuration to that of a single lag screw or helical blade under dynamic loading.”


Case Studies

Textbook Case Study- 83 YOF with a Peritrochanteric Hip Fracture
Fixation and intraoperative compression of a peritrochanteric hip fracture 83-year-old female, three-part peritrochanteric hip fracture

Case Study- 48 YOM with a Peritrochanteric Hip Fracture
Cephalomedullary nailing and intraoperative compression of a peritrochanteric hip fracture
48-year-old male, injured in a fall causing a two-part peritrochanteric hip fracture

Design and Technology


View the Video of the TRIGEN INTERTAN Compression

• Active linear compression - compression of the fracture with rotational control
• Eliminates excessive sliding reducing the incidence of femoral neck shortening
• Medial migration and Z-effect nearly impossible

Steps of active linear compression

• Smaller 7mm compression screw head engages the nail
• The 11mm lag screw and femoral neck/head begin to move laterally
• Nail and shaft of the femur begin to move medially
• Linear compression is achieved in a controlled fashion

Active linear compression helps unload the lateral wall and restore the proximal femur. Note: The INTERTAN compression screw is always against the nail. This makes medial migration and the Z-effect nearly impossible.

View the Video of the TRIGEN INTERTAN Compression in Fluoro

Trapezoidal nail shape
• Small proximal diameter of the nail (15.25mm x 16.25mm)
• More material on the lateral side of the nail preserves the lateral wall
• Helps combat forces that cause instability and varus collapse
• Provides a press-fit in the metaphyseal region of the proximal femur


Clothes pin distal tip
• Less rigid than conventional devices
• Reduces the incidence of anterior thigh pain
• Reduces chance for secondary femoral shaft fractures

References

1. Rueger Johannes; Moore Chris. Shortening of the Femoral Neck Following Peritrochanteric Fracture. Bone & Joint Science. Vol. 2, No. 5, May 2011.

Indications


Indications for TRIGEN INTERTAN

Fractures of the femur including:

• Simple shaft fractures
• Comminuted shaft fractures
• Spiral shaft fractures
• Long oblique shaft fractures
• Segmental shaft fractures
• Subtrochanteric fractures
• Intertrochanteric fractures
• Ipsilateral femoral shaft/neck fractures
• Intracapsular fractures
• Nonunions and malunions
• Polytrauma and multiple fractures
• Prophylactic nailing of impending pathologic fractures
• Reconstruction following tumor resection and grafting
• Bone lengthening and shortening

Download the Surgical Technique

View Surgical Video

FAQs


INTERTAN FAQs

Why does the INTERTAN nail have a trapezoidal shape?

The smaller cross-section of the INTERTAN nail has the advantage of preserving the Gluteus Medius Tendon while at the same time not compromising the overall strength of the implant. The trapezoidal shape of the nail places more material at the lateral side of the implant where tensile forces are typically the strongest. In addition, the nail's trapezoidal profile also provides enhanced anatomical fit and added rotational stability in the proximal femoral metaphysis similar to that offered by conventional hip stems.

What is an Integrated Interlocking Screw configuration and how will it help my patients?

The integrated interlocking screws of the INTERTAN system increase stability and resistance to both intra and post-operative fracture rotation about the implant by providing two points of fixation within the femoral neck and head. This directly reduces rotational instability and eliminates the possibility of implant failure due to Z-Effect. The integrated screw configuration is a fourth generation intramedullary nail concept combining the enhanced rotational stability of the TRIGEN Reconstruction Nail with the superior controlled sliding and compression of the IMHS™ implant. The INTERTAN system incorporates the best aspects of both devices by providing both single and dual integrated lag screws for the treatment of most major fracture patterns.

What is Z-Effect and how does INTERTAN solve it?

Z-Effect is an unfortunate by-product of most intramedually nails that utilize two screws placed up into the femoral neck and head. Typically, the superior screw is of smaller diameter than the inferior and bears a disproportionate amount of load during weight bearing. Excessive varus forces placed on the smaller screw at the lateral cortex cause it to toggle and either back out or migrate through the femoral head into the acetabulum. The larger inferior screw is neither keyed in rotation nor locked in place, and it too will either back out or migrate medially. The resultant Z-Effect where the two screws move in opposite directions is one mode of failure for the conventional two screw reconstruction device. The INTERTAN nail turns that construct upside down and integrates the two screws so that they act as one device to bear all load, enact all compression and prevent excessive medial or lateral migration thus negating the Z-Effect.

Why does the short nail have a clothespin distal tip?

The clothespin distal tip of the INTERTAN short nail reduces the overall cross-sectional stiffness of the implant to minimize the risk of iatrogenic fracture during insertion, to ease the actual process of nail insertion and to offer enhanced rotational stability within the proximal femoral canal. As the distal tip of the INTERTAN nail encounters the AP bow of the proximal femur, it closes slightly changing the implant's straight profile to bent. This has the advantage of lessening point stresses about the distal tip of the nail and reducing the possibility of fracture due to a stress riser at that location.

I have been using a single screw IM device for the last 20 years and have yet to have one cut out. Do I have to use the integrated screws?

Absolutely not. One of the advantages of the INTERTAN system is that it provides you with options to treat a wide variety of fracture patterns. However, you are probably well aware that approximately 25% of all hip fractures are unstable and one in five (20%) will actually fail due to implant cut out.

Our designing surgeons feel that rotational instability is a major contributing factor to that failure rate and propose the INTERTAN nail as the solution to this dilemma. The problem lies in the fact that even implants that are keyed to prevent rotation can still experience rotation of the fragments about the axis of the lag screw. Placement of a secondary point of fixation into the femoral neck and head reduces the chances of rotation but adds the secondary concern of Z-Effect.

Watch video of head rotations with a conventional single lag screw device

The INTERTAN nail solves that problem by integrating two screws so that they function as one unit to prevent rotation and excessive screw migration. Mechanical testing of the two screw construct was stopped at 100,000 cycles with no evidence of implant cut out, further reinforcing the INTERTAN nail philosophy.

For additional questions, please contact your local sales representative.

References
1. www.aaos.org
2. http://www.springerlink.com/content/f9np64c0v3hch57w/
3. Koval KJ; Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg (A). 1994: 76-1, 751-758.
4. AAOS Position Statement 1144. Hip fracture in seniors: A call for health system reform.
5. Rueger Johannes; Moore Chris. Shortening of the Femoral Neck Following Peritrochanteric Fracture. Bone & Joint Science. Vol. 2, No. 5, May 2011
6. Rueger J, Moore C. Shortening of the Femoral Neck Following Peritrochanteric Fracture. Bone&Joint Science ( www.KLEOS.md) 2011; 2(5)