{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:27:11Z","timestamp":1792070831365,"version":"4.4.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,2,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Subtrochanteric proximal femoral fractures are generally treated with cephalomedullary nail fixation. We aimed to compare outcomes of subtrochanteric fracture fixation using a single lag screw (Gamma3 nail, GN) or dual lag screw (INTERTAN nail, IN) device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The primary outcome measure was mechanical failure, defined as lag screw cut-out or back-out, nail breakage, or peri-implant fracture. Secondary outcomes included reoperation for mechanical failure, deep infection, or nonunion, and technical predictors of mechanical failure. Adult patients (\u226518 years of age) with a subtrochanteric proximal femoral fracture treated at a single center were retrospectively identified using electronic records. All patients who underwent fixation using either a long GN (November 2010 to January 2017) or IN (March 2017 to April 2022) were included. Medical records and radiographs were reviewed to identify operative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 587 patients were included: 336 in the GN group (median age, 82 years; 73% female) and 251 in the IN group (median age, 82 years; 71% female). The risk of mechanical failure was 3-fold higher in the GN group (adjusted hazard ratio [aHR], 2.87; p = 0.010), with screw cut-out (p = 0.04) and back-out (p = 0.04) only observed in the GN group. We observed a greater risk of reoperation for mechanical failure in the GN group, but this did not achieve significance (aHR, 2.02; p = 0.16). Independent predictors of mechanical failure included varus malalignment of &gt;5\u00b0 for cut-out (aHR, 17.43; p = 0.012), a tip-to-apex distance of &gt;25 mm for back-out (aHR, 9.47; p = 0.019), and shortening of &gt;1 cm for peri-implant fracture (aHR, 5.44; p = 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>For older patients with subtrochanteric and reverse-oblique femoral fractures, the dual lag screw design of the IN nail was associated with a lower risk of mechanical failure compared with the single lag screw design of the GN nail.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00404","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T14:00:47Z","timestamp":1735048847000},"page":"389-396","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Cephalomedullary Nailing for Subtrochanteric and Reverse-Oblique Femoral Fractures"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6223-9488","authenticated-orcid":false,"given":"Andrew D.","family":"Ablett","sequence":"first","affiliation":[{"name":"Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7443-4256","authenticated-orcid":false,"given":"Conor","family":"McCann","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5118-7626","authenticated-orcid":false,"given":"Tony","family":"Feng","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2155-8726","authenticated-orcid":false,"given":"Victoria","family":"Macaskill","sequence":"additional","affiliation":[{"name":"University of Edinburgh Medical School, Edinburgh, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8976-2260","authenticated-orcid":false,"given":"William M.","family":"Oliver","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2370-8461","authenticated-orcid":false,"given":"John F.","family":"Keating","sequence":"additional","affiliation":[{"name":"Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom"},{"name":"University of Edinburgh Medical School, Edinburgh, Scotland, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"issue":"1","key":"bib1-20250219","doi-asserted-by":"crossref","first-page":"12734","DOI":"10.1038\/s41598-023-40087-8","article-title":"Epidemiology 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Open."},{"issue":"1","key":"bib5-20250219","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/BOT.0b013e31819211b2","article-title":"The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression","volume":"23","author":"Ruecker","year":"2009","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib6-20250219","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1111\/os.12853","article-title":"Biomechanical Comparison of INTERTAN Nail and Gamma3 Nail for Intertrochanteric Fractures","volume":"12","author":"Luo","year":"2020","journal-title":"Orthop Surg."},{"issue":"11","key":"bib7-20250219","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1007\/s00264-010-1199-x","article-title":"Internal fixation of femoral neck fractures with posterior comminution: a biomechanical comparison of DHS\u00ae and Intertan 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Non-prosthetic peri-implant fractures: classification, management and outcomes","volume":"138","author":"Chan","year":"2018","journal-title":"Arch Orthop Trauma Surg."},{"issue":"Suppl 1","key":"bib14-20250219","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation Classification Compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib15-20250219","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1302\/0301-620X.96B8.33644","article-title":"Predictors of failure for cephalomedullary nailing of proximal femoral fractures","volume":"96-B","author":"Kashigar","year":"2014","journal-title":"Bone Joint J."},{"issue":"2","key":"bib16-20250219","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1097\/OI9.0000000000000191","article-title":"Tips and tricks to avoid implant failure in proximal femur fractures treated with cephalomedullary nails: a review of the literature","volume":"5","author":"Petfield","year":"2022","journal-title":"OTA Int."},{"issue":"6","key":"bib17-20250219","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/BOT.0000000000000835","article-title":"Proximal Femoral Shortening After Cephalomedullary Nail Insertion for Intertrochanteric Fractures","volume":"31","author":"Gilat","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib18-20250219","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s00068-021-01834-6","article-title":"Management of subtrochanteric femur fractures: is open reduction associated with poor outcomes?","volume":"48","author":"Panteli","year":"2022","journal-title":"Eur J Trauma Emerg Surg."},{"issue":"1","key":"bib19-20250219","doi-asserted-by":"crossref","first-page":"15962","DOI":"10.1038\/s41598-017-16315-3","article-title":"Comparison of clinical outcomes with InterTan vs Gamma nail or PFNA in the treatment of intertrochanteric fractures: A meta-analysis","volume":"7","author":"Ma","year":"2017","journal-title":"Sci Rep."},{"issue":"5","key":"bib20-20250219","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1002\/jor.21236","article-title":"Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method","volume":"29","author":"Born","year":"2011","journal-title":"J Orthop Res."},{"issue":"5","key":"bib21-20250219","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/BOT.0000000000000008","article-title":"Malpositioning of the lag screws by 1- or 2-screw nailing systems for pertrochanteric femoral fractures: a biomechanical comparison of Gamma 3 and InterTan","volume":"28","author":"N\u00fcchtern","year":"2014","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib22-20250219","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/BOT.0000000000000552","article-title":"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","volume":"30","author":"Santoni","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib23-20250219","doi-asserted-by":"crossref","first-page":"e0026","DOI":"10.2106\/JBJS.OA.17.00026","article-title":"Implant-Related Complications and Mortality After Use of Short or Long Gamma Nail for Intertrochanteric and Subtrochanteric Fractures: A Prospective Study with Minimum 13-Year Follow-up","volume":"2","author":"Horner","year":"2017","journal-title":"JB JS Open Access."},{"issue":"5","key":"bib24-20250219","first-page":"435","article-title":"Implant breakage, a rare complication with the Gamma nail. A review of 843 fractures of the proximal femur treated with a Gamma nail","volume":"70","author":"Alvarez","year":"2004","journal-title":"Acta Orthop Belg."},{"issue":"4","key":"bib25-20250219","first-page":"552","article-title":"Failure of the titanium trochanteric Gamma nail in ununited metastatic fractures","volume":"78","author":"Maes","year":"2012","journal-title":"Acta Orthop Belg."},{"key":"bib26-20250219","first-page":"172352","article-title":"Breakage of a third generation Gamma nail: a case report and review of the literature","volume":"2013","author":"Iwakura","year":"2013","journal-title":"Case Rep Orthop."},{"issue":"2","key":"bib27-20250219","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s00402-014-2121-6","article-title":"Breakage of cephalomedullary nailing in operative treatment of trochanteric and subtrochanteric femoral fractures","volume":"135","author":"von R\u00fcden","year":"2015","journal-title":"Arch Orthop Trauma Surg."},{"issue":"7","key":"bib28-20250219","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1530\/EOR-21-0067","article-title":"Reoperation rates after proximal femur fracture fixation with single and dual screw femoral nails: a systematic review and meta-analysis","volume":"7","author":"Sivakumar","year":"2022","journal-title":"EFORT Open Rev."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:51:10Z","timestamp":1787752270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00404"}},"subtitle":["Comparison of a Single Versus Dual Lag Screw Device"],"short-title":[],"issued":{"date-parts":[[2024,12,24]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.00404","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,24]]}}}