Global

‡ In these countries please contact our distributor

TRIGEN INTERTAN

Intertrochanteric Antegrade Nail

TRIGEN INTERTAN

About

Your patients can enjoy life after hip fracture

The evidence is in!  Based on data from more than two-dozen published studies, the TRIGEN INTERTAN Intertrochanteric Antegrade Nail allows femur (hip) fracture patients to experience:

  • Lower risk of implant failure and non-union6,7,8,9,10,11,12,13,14,15
  • Reduced postoperative pain9,10,11,13,14,15
  • Faster time to fracture union9,11,12,13,19,23,24,25,26,27,28,29
  • Proven high return to pre-fracture status6,13,19,23

 

Features and Benefits

  • Maintain compression and eliminate Z-effect
  • Intertrochanteric rotational stability
  • Control rotation during reduction
  • Eliminate medial migration
  • Prevent periprosthetic fractures

Downloadable resources

TRIGEN INTERTAN Claims Brochure

Bone and Joint Outcome Whitepaper

 

INTERTAN claims image - How INTERTAN works

Challenge:  Post-Operative Complications

Solution:  Lower risk of implant failure and non-union6,7,8,9,10,11,12,13,14,15

TRIGEN INTERTAN Solution:  lower risk of implant failure and non-union

Challenge:  Pain management

Solution:  Reduced postoperative pain9,10,11,13,14,15

TRIGEN INTERTAN Solution:  reduced postoperative pain

Challenge:  Delayed healing

Solution:  Faster time to fracture union9,11,12,13,19,23,24,25,26,27,28,29

TRIGEN INTERTAN Solution:  faster time to fracture union

Challenge:  Poor functional outcomes

Solution:  Proven high return to pre-fracture status6,13,19,23

TRIGEN INTERTAN Solution:  proven high return to pre-fracture status

 

References:
1.American Academy of Orthopaedic Surgeons. Hip fractures in seniors: a call for health system reform. Position Statement 1144. Rosemont, IL: 1999. 
2. Mundi S et al. Similar mortality rates in hip fracture patients over the past 31 years: A systematic review of RCTs. Acta Orthopaedica 2014; 85(1): 54-59. 
3. Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am. J Epidemiol. 2009 Nov 15;170(10):1290-9. doi: 10.1093/aje/kwp266. 
4. Brujin K, Hartog D, Tuinebreijer W, Roukema G. Reliability of Predictors for Screw Cutout in Intertrochanteric Hip Fractures. J Bone Joint Surg Am. 2012;94:1266-1272. 
5. Hoffmann S, Paetzold R, Stephan D, Püschel K, Buehren V, Augat P. Biomechanical evaluation of interlocking lag screw design in intramedullary nailing of unstable pertrochanteric fractures. J Orthop Trauma. 2013;27(9):483-490. 
6. Berger-Groch J, Rupprecht M, Schoepper S, Schroeder M, Rueger JM, Hoffmann M. Five-Year Outcome Analysis of Intertrochanteric Femur Fractures: A Prospective Randomized Trial Comparing a 2-Screw and a Single-Screw Cephalomedullary Nail. J Orthop Trauma. 2016;30:483-488. 
7. Matre K, Vinje T, Havelin LI, et al. TRIGEN INTERTAN intramedullary nail versus sliding hip screw:a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of follow-up. J Bone Joint Surg Am. 2013;95:200-208. 
8. Sanders D, Bryant D, Tieszer C, et al. A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures. J Orthop Trauma. 2017;31:1-8. 
9. Seyhan M, Turkmen I, Unay K, Ozkut AT. Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study. J Orthop Sci. 2015;20:1053-1061. 
10. Su H, Sun K, Wang X. A randomized prospective comparison of Intertan and Gamma3 for treating unstable intertrochanteric fractures. Int J Clin Exp Med. 2016;9:8640-8647. 
11. Zhang S, Zhang K, Jia Y, Yu B, Feng W. InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013;36:e288-294 
12. Wang Q, Yang X, He HZ, Dong LJ, Huang DG. Comparative study of InterTAN and Dynamic Hip Screw in treatment of femoral intertrochanteric injury and wound. Int J Clin Exp Med. 2014;7:5578-5582. 
13. Wu Y, Watson JT, Kuldjanov D, Jackman J. Rotationally stable fixation for intertrochanteric hip fractures: the Intertan experience, surgical technique, and outcomes. Techniques in Ortho. 2014;29;3:120-132 
14. Yu W, Zhang X, Zhu X, Hu J, Liu Y. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly. J Orthop Surg Res. 2016;11:10. 
15. Zehir S, Sahin E, Zehir R. Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures. Ulus Travma Acil Cerrahi Derg, 2015;21(6:469-476. 
16. Leo N, Dunbar C, Ridgway J, Horner A. The TRIGEN INTERTAN Intertrochanteric Antegrade Nail: A Systematic Literature Review and Meta-analysis of Clinical Outcomes Compared to Standard of Care in the Treatment of Intertrochanteric Hip Fractures. Bone&Joint Outcome. 2017:4(1):1-20. Lit no: 10205 V1 07/17.
17. Serrano-Riera R, Blair JA, Downes K, Sanders R. Cephalo-medullary nail fixation of intertrochanteric fractures: are two proximal screws better than one? Abstract presented at: Orthopaedic Trauma Association Annual Meeting; October 15-18, 2014; Tampa, FL, USA. 
18. Santoni B, Nayak A, Cooper S, et al. Comparison of Femoral Head Rotation and Varus Collapse Between a Single Lag Screw and Integrated Dual Screw Intertrochanteric Hip Fracture Fixation Device Using a Cadaveric Hemi-Pelvis Biomechanical Model. J Orthop Trauma. 2016;30:164-169. 
19. Ruecker AH, Rupprecht M, Gruber M, Gebauer M, Barve s using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma 2009;23:22–30 
20. Galli M, Ciriello V, Bocchino L, Gangemi NM, Peruzzi M, Marzetti E. Clinical and functional outcomes of internal fixation with intertrochanteric antegrade nail in older patients with proximal extracapsular femoral fractures. Eur J Trauma Emerg Surg. 2013/10/17 2013:1-6. 
21. Zanzone A. Current Challenges in Pain Management in Hip Fracture Patients. J Orthop Trauma. 2016;30:S1-S5. 
22. Abou-Setta A, Beaupre L, Jones C, et al. Pain Management Interventions for Hip Fracture. Agency for Healthcare Research and Quality. 2011;Publication No. 11-EHC022-EF. 
23. Kim JW, Kim TY, Ha YC, Lee YK, Koo KH. Outcome of intertrochanteric fractures treated by intramedullary nail with two integrated lag screws: A study in Asian population. Indian J Orthop. 2015;49:436-441. 
24. Tao R, Lu Y, Xu H, Zhou ZY, Wang YH, Liu F. Internal fixation of intertrochanteric hip fractures: a clinical comparison of two implant designs. Sci World J. 2013;2013:1-8. 
25. Huang FT, Lin KC, Yang SW, Renn JH. Comparative study of the proximal femoral nail antirotation versus the reconstruction nail in the treatment of comminuted proximal femoral fracture. Orthopedics. 2012;35:e41-47. 
26. Sahin EK, Imerci A, Kinik H, Karapinar L, Canbek U, Savran A. Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol. 2014;24:347-352. 
27. Hsueh K, Fang C. Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients. Int Orthop. 2010;34:1273-1276. 
28. Liu Y, Tao R, Liu F, et al. Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. 2010;41:810-817. 
29. Riha D, Bartoni´cek J. Internal fixation of pertrochanteric fractures using DHS with a two-hole side-plate. Int Orthop. 2010;34:877-882. 
30. Gaston MS, Simpson AHRW. Inhibition of fracture healing.J Bone Joing Surg Br. 2007:89-B:1553-1560. 
31. Rueger J, Moore C. Shortening of the femoral neck following peritrochanteric fracture. Bone Joint Sci. 2011 May;2(5). 
32. Zlowodzki M, Brink O, Switzer J, et al. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip. J Bone Joint Surg Br. 2008;90:1487-1494. 
33. Baldwin P, Lavender R, Sanders R, Koval K. Controversies in Intramedullary Fixation for Intertrochanteric Hip Fractures. J Orthop Trauma. 2016;30:635-641. 
34. Ollivere B, Das A, Shivji F. Hip fractures: The state of the art in 2017. The British Editorial Society of Bone & Joint Surgery. 2017;6:3.

05036 V2 0817

Disclaimer: The results of in vitro simulation testing have not been proven to predict clinical performance.

Some products are not available in all countries.   Please contact your local rep for additional information or fill out our contact us form.  

Clinical evidence

TRIGEN INTERTAN Clinical Evidence

Your patients can enjoy life after hip fracture

The evidence is in!  Based on data from more than two-dozen published studies, the TRIGEN INTERTAN Intertrochanteric Antegrade Nail allows patients to experience

TRIGEN INTERTAN Claims Brochure

Bone and Joint Outcome Whitepaper

Disclaimer

The results of in vitro simulation testing have not been proven to predict clinical performance.

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 do I ream with a 16mm channel reamer and the nail size is larger?

Upon its initial insertion into the proximal femur, the INTERTAN nail exerts a small amount of press-fit within the canal by virtue of its trapezoidal cross-section. Once the correct degree of femoral neck anteversion has been determined, the nail can then be impacted into the proximal femoral metaphysis acting essentially as a broach to further enhance the initial press-fit. This has the distinct advantage of fixing the nail in correct orientation with respect to neck anteversion and preventing excessive rotation of the nail within the canal and possible soft tissue tethering/damage. The 17mm reamer is available to accommodate those instances when dense bone is encountered such that it precludes that initial press-fit.

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.

If I only use the single subtrochanteric lag screw option does that create a stress riser at the empty inferior hole in the nail?

Fatigue testing was performed with the nail and single subtrochanteric screw construct undergoing a typical 10° adduction/flexion cycle. This is the same orientation used in the testing of femoral stems for total joint replacement. The INTERTAN nail was compared to the TAN nail in two screw reconstruction nail mode and was found to be equally as strong, completing 500,000 cycles at 350 lbs load without failure. This is representative of approximately six months implantation time at which fracture union should have occurred. Our mechanical testing data reveals no significant stress riser occurring at that point.

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. 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.

What is the lateral valgus offset of the INTERTAN nail?


The INTERTAN nail has a 4° valgus offset, allowing for an optimal insertion trajectory into the femoral canal. Excessively lateral nail insertion can cause damage to the abductor muscle group, the effects of which are not entirely clear. Recent literature (JOT Vol. 19, #10. November/December 2005 pp. 681- 685) states that a nail starting point at the tip or even just medial to the tip provides excellent fracture alignment results. A 4°, 5° or 6° valgus offset may not be of major clinical significance as stand alone variables. They must be examined relative to the location of the offset, the AP bow of the nail and the location of the nail entry point in both the AP and LM planes in order to get a complete picture.

How do I know when to use the integrated interlocking screws vs. the single subtrochanteric lag screw option with the INTERTAN nail?
Approximately 25% of proximal femur fractures are biomechanically unstable and one in five (20%) will fail due to femoral neck/head cut out. These fractures require enhanced fixation in order to maximize their postoperative stability, and single screw, keyed implants can still experience rotational instability about the lag screw. The INTERTAN integrated interlocking screws provide enhanced rotational stability and superior weight-bearing capability. The active linear compression driven by the integrated screws gives the surgeon clear visible and tactile confirmation of intraoperative fracture reduction. The dual screw option is ideal for unstable fractures or for those surgeons simply wanting enhanced confirmation of fracture reduction. Surgeons comfortable with the single subtrochanteric lag screw will appreciate the fact that the INTERTAN nail provides that as well.

Why does Smith & Nephew have two implants (INTERTAN nail & IMHS™ CP hip screws) that treat the same fractures?

No two fractures are exactly alike and so to say that one implant can adequately treat every injury is misleading. In as much, we need to look at the INTERTAN nail and IMHS CP hip screw as two very different stand- alone systems that complement one another. We want to appeal to as wide a customer base as possible and feel that we would be doing a disservice to our surgeons if we attempted to give them one nail to treat every fracture that walked through their clinic door. IMHS CP hip screws are proven in the literature to out-perform the Gamma-type device in postoperative controlled sliding. Its lower coefficient of friction facilitates superior sliding of the lag screw within the barrel of the nail relative to other single screw devices to promote fracture healing. The INTERTAN nail offers a two screw solution for enhanced rotational stability and active linear compression for visual and tactile compression of the fracture. The integrated interlocking screws provide superior life to cut out and so offer surgeons a viable treatment modality for highly unstable fracture patterns. Smith & Nephew is a solutions-based medical device company and as such we are geared to providing our surgeons with a wide variety of products for the treatment of their patients.

Why do I ream with a 16mm reamer and the nail size is larger?

Proximally, the width of the INTERTAN nail measures 16.25mm x 15.25mm. This trapezoidal cross-section allows a larger diameter nail to fit into a smaller hole thus reducing the total amount of bone removed. The nail's shape in association with the smaller entry portal give it enhanced rotational stability within the proximal femur. The trapezoidal vertices of the nail cause it to press-fit into the
femoral metaphysis and provide enhanced rotational control vs. a round geometry nail. This is important in the proximal femur where maintenance of correct femoral neck anteversion during lag screw placement is essential to the prevention of implant cut out. Should the surgeon encounter very dense bone during nail insertion, the 17mm reamer will over-ream the proximal femur and allow the nail to slide more freely into the canal. This does, however, negate the press-fit effect created by the nail's trapezoidal shape.

What is the length of the short INTERTAN nail?

The short INTERTAN nail is available in 18cm and 20cm lengths. Some surgeons feel that the longer 20cm nail provides enhanced interference fit within the femoral diaphysis thus preventing fracture rotation about the nail. Both implants have a straight profile, but the clothespin distal tip closes slightly as it encounters the AP bow in the femur in order to reduce point stresses about the nail tip. This has the advantage of reducing the likelihood of iatrogenic fracture of the femur at the nail tip due to a stress riser. The same clothespin distal tip characteristics are available in the more frequently implanted 18cm nail as well.

This information is intended for health care professionals only.

*The decision to use Smith & Nephew products should be made by a healthcare professional, in line with applicable local protocols.  Smith & Nephew products should always be used for the indications set out in the applicable instructions for use.