title: Short reconstruction nail for intertrochanteric fracture: does it really fit Asian feature?
abstract: BACKGROUND
  The Trigen short reconstruction trochanteric antegrade nail (TAN) is considered most suitable for the small skeletons of Asian patients. We have evaluated the results of TAN for intertrochanteric fractures in Asian patients.
  
  
  METHODS
  Between January 2006 and March 2009, 174 fractures in 164 patients were treated by TAN in our department. Epidemiological data, radiological changes, fracture types, cortical bone indices, clinical outcomes, and complications over a mean of 26 months were analyzed retrospectively.
  
  
  RESULTS
  We observed a 17.0% fracture rate at the tip of the nail, a poor reduction rate of 15.9%, and a 41.4% cracking rate of the lateral trochanter for type 31-A3 fracture. Review of these cracking cases showed that they were all type 31-A3 unstable fractures combined with comminuted lateral trochanter fractures. Two shaft fractures required revision, with other fractures showing no delayed union, nonunion or infection. No screw breakage but one cut-out occurred, which received total hip arthroplasty revision. All other fractures healed at last. Risk of distal shaft fractures was not associated with patient age, gender, fracture type or cortical bone index.
  
  
  CONCLUSIONS
  Despite the theoretically better design of TAN and the healing of most fractures and good activity at last follow-up, poor reduction and coxa vara caused by insertion of the nail could not be completely avoided, and the design of the distal part of the nail had the potential to cause femoral shaft fracture. Future improvements are necessary to enable the use of this system in Asians.
authors.affiliation: Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, People's Republic of China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhao
authors.forename: Shi-Gui
authors.initials: SG
authors.lastname: Yan
authors.forename: Hang
authors.initials: H
authors.lastname: Li
authors.forename: Hao-Bo
authors.initials: HB
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001858:Bone Nails / Q000009:adverse effects; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006620:Hip Fractures / Q000208:ethnology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome