The Long Trochanteric Fixation Nail (LTFN) is a titanium alloy cephalomedullary nail indicated for treatment of proximal femur fractures, including intertrochanteric and subtrochan-

ABSTRACT The Long Trochanteric Fixation Nail (LTFN) is a titanium alloy cephalomedullary nail indicated for treatment of proximal femur fractures, including intertrochanteric and subtrochanteric varieties. Between 03/01/2002, and 10/01/2003, 211 consecutive fractures classified either as “intertrochanteric” or “subtrochanteric” were treated surgically at involved study centers. Fifty of these fractures were identified as being unstable intertrochanteric or subtrochanteric fractures treated with the LTFN and were selected as the study population, including 14 intertrochanteric fractures with reverse obliquity (AO Type 31-A3) and 29 with subtrochanteric extension. At average 11 – month follow-up, mean Functional Recovery Score was 85. At average 9 – month radiographic follow-up, 37 of 38 hips for which complete radiographic data sets were available healed, for a union rate of 97%. There were no cut – out failures of the helical blade providing proximal fixation for the implant. We recommend the LTFN for treatment of subtrochanteric fractures and unstable intertrochanteric fractures, including those with reverse obliquity. INTRODUCTION Küntscher introduced intramedullary fixation of femoral shaft fractures in 1940, and indications for intramedullary intstrumentation of the femur have continued to expand as designs have evolved.1 Current second – generation, cephalomedullary nails permit purchase in the femoral neck and head for proximal fixation as well as providing distal locking capacity for axial and torsional control. We report our initial experience with the use of the Long Trochanteric Fixation Nail (LTFN, Synthes, Paoli, PN), a second – generation cephalomedullary implant, for the treatment of subtrochanteric and unstable intertrochanteric fractures. MATERIALS AND METHODS Approval for this study was obtained from our Institutional Review Board. Between 03/01/2002, and 10/01/2003, 211 intertrochanteric and subtrochanteric fractures of the proximal femur underwent operative treatment at one of two Level One Trauma Centers involved in this study. Of these fractures, 53 were treated with the Long Trochanteric Fixation Nail (LTFN, Synthes, Paoli, PA). Fifty of those fractures treated with the LTFN were classified as either subtrochanteric or unstable intertrochanteric fractures according to the Orthopaedic Trauma Association (OTA) system. This subset of 50 fractures in 50 patients constituted the subject population for this study. Subjects included 28 males and 22 females with a mean age of 68 years (range, 18 – 93 years). Preoperatively, 24 (60%) of patients were community ambulators without limitation, and an additional 7 (18%) had only minor limitations, requiring use of a cane. Mechanism of injury qualified as low energy in the majority of patients (62%), with the predominant etiology being a fall from standing height. Pathologic fractures were observed in two patients, and the remainder of patients experienced high – energy mechanisms including: fall from a height ≥ 10 feet (6 patients), motor vehicle accident (5 patients), pedestrian versus motor vehicle (2 patients), gunshot wound (1 patient), downhill skiing (1 patient) and downhill sledding (1 patient). All fractures were classified using the OTA comprehensive system of fracture classification and for purposes of historical comparison, intertrochanteric fractures were classified according to the system of Kyle and colleagues, and subtrochanteric fractures according to the system of Seinsheimer.2-4 There were 29 subtrochanteric fractures and 14 intertrochanteric fractures with reverse obliquity. In 46 cases (92%) use of the LTFN represented the index procedure, and in 4 cases the LTFN was used to revise a prouSe Of The lOng TrOchanTeric fiXaTiOn nail fOr unSTable inTerTrOchanTeric and SubTrOchanTeric fracTureS