Implantation of INTERTANTM nail in four patients with intertrochanteric fractures leading to single or comminute fractures: pitfalls and recommendations: a case series (Journal of Medical Case Reports)

IntroductionIntraoperative technical complications are occasionally encountered while implanting INTERTANTM nails for intertrochanteric fractures. Surgeons need to pay attention to the difficulties they may encounter during the implantation of an INTERTANTM nail.Case presentationWe report four cases with intraoperative difficulties during the implantation of INTERTANTM nails among Han Chinese patients from mainland China. In Case 1, during the operation on a 75-year-old woman, an anatomical specificity of excessive femoral shaft curvation at the coronal and sagittal planes was observed; a relatively smooth implantation was achieved by adjusting the item point. In Case 2, due to fat obstruction, an INTERTANTM nail was implanted at an oblique angle in 64-year-old obese woman, which resulted in an iatrogenic fracture of the proximal femur. In Case 3, an iatrogenic fracture of the distal femur developed in an 83-year-old woman because of violent hammering and underestimating of bone fragility. In Case 4, an iatrogenic fracture occurred in a 40-year-old woman around the distal locking slot during the drilling process. Conclusions: Preoperative evaluation should be considered as an important preparation for the implantation of an INTERTANTM nail. Full-length anteroposterior and lateral radiographs of the injured femur are necessary to confirm the anatomical specificity. The vertical trajectory as well as sufficient reaming is important in reducing the possibility of iatrogenic fractures, particularly for obese patients. In older patients, violent hammering should be avoided and full reaming is recommended even if the canal seems to be wide enough. For cases where hard fracture reduction is predicted, the strategy of open reduction and fixation with a dynamic hip screw seems to be more rational and should be considered as an alternative method.