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Cephalomedullary Nail Fixation of Intertrochanteric Femur Fractures: Are Two Proximal Screws Better Than One?

Serrano, Rafael MD*; Blair, James A. MD; Watson, David T. MD; Infante, Anthony F. Jr DO; Shah, Anjan R. MD; Mir, Hassan R. MD, MBA; Maxson, Benjamin J. DO; Downes, Katheryne W. PhD, MPH§; Sanders, Roy W. MD


In the article that appears on page 577 of the November issue of Journal of Orthopaedic Trauma , one of the authors’ names was listed incorrectly. The correct listing is: Downes KL.

Journal of Orthopaedic Trauma. 32(2):e75, February 2018.

doi: 10.1097/BOT.0000000000000967
Original Article

Objectives: To analyze radiographic changes in intertrochanteric (IT) fracture alignment after treatment with either a single sliding lag screw or an integrated compressed and locked, dual screw, cephalomedullary nail construct.

Design: Retrospective comparative study.

Setting: Level 1 regional trauma center.

Patients: 1004 OTA/AO 31A, 31B2.1 fractures treated with either a single screw cephalomedullary nail (Gamma 3) or an integrated dual screw cephalomedullary nail (InterTAN) between February 1, 2005, and June 30, 2013. Four hundred thirteen remained after exclusion criteria; 130 were treated with a single screw device (79 stable and 51 unstable), and 283 with an integrated dual screw device (155 stable and 128 unstable).

Intervention: Cephalomedullary nail insertion.

Outcome Measures: Radiographic analysis included fracture pattern, fracture reduction, neck-shaft angle (NSA), and femoral neck shortening (FNS) differences at 3, 6, and 12 months. Measurements were normalized using known lag screw dimensions, digitally corrected for magnification. Rotation between x-rays was controlled using a ratio of known to measured dimensions. The Mann–Whitney U test was used for statistical analysis.

Results: The single screw device resulted in 2.5 times more varus collapse (NSA) and 2 times more FNS over 1 year, as compared to the locked, integrated dual screw device, regardless of stability (P < 0.001). NSA and FNS changes were greater for both devices in unstable fracture patterns, but significantly less movement occurred with the dual screw device (P < 0.001).

Conclusions: A cephalomedullary nail with 2 integrated proximal screws that can be compressed and then locked seems to maintain initial IT fracture reduction and subsequent position over time, with less varus collapse and less shortening than a single screw device.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Supplemental Digital Content is Available in the Text.

*Department of Orthopaedics, University of South Florida, Tampa, FL;

Department of Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX;

Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and

§Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

Reprints: Rafael Serrano, MD, Department of Orthopaedics, University of South Florida, 5 Tampa General Circle, Suite 710, Tampa, FL 33606 (e-mail:

The authors report no conflict of interest.

Presented in part at the Annual Meeting of the Orthopaedic Trauma Association, October 15, 2014, Tampa, FL.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted July 12, 2017

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