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Intramedullary hip screws compare favorably with gamma, proximal femoral nails for reverse oblique intertrochanteric fracture fixation
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The intramedullary hip screw may represent a viable option for the treatment of reverse oblique intertrochanteric fractures (OTA/AO 31-A3), with results similar to those of other cephalomedullary devices, according to orthopaedic investigators.
“There have been a number of cephalomedullary devices used for fixation of this unstable fracture,” Daud Chou said during his presentation at the 2010 EFORT Congress. “The gamma nail has shown to be a good device for these fractures, with a failure rate of 17%. The proximal femoral nail has also been used and shows a failure rate of about 9%.”
Chou and colleagues retrospectively reviewed clinical and radiological records for 63 reverse oblique intertrochanteric fractures treated with the intramedullary hip screw (IMHS) at their institution between 1999 and 2008. Duration of follow-up ranged from 8 months to 6 years, Chou said.
Outcomes, complications
Satisfactory reduction was achieved in 56 of the 63 fractures included in the study. Chou reported only one poorly positioned IMHS in the femoral head. No cases presented evidence of femoral shaft fracture, screw cut-out or collapse at the fracture site.
“Moving on to the complications that we saw, we defined fixation failure as the need for reoperation, and we had 9.5% fixation failure,” Chou said.
Orthopaedic complications included two cases of malrotation, two cases of nonunion, one case of deep infection, two cases of distal locking bolts backing out and one cracked nail. Mortality at 30 days was 6.5%.
Due to the unique biomechanical properties of reverse oblique intertrochanteric fractures, difficulties have been reported obtaining stable fixation with the conventional sliding dynamic condylar screw. Chou reported that recent studies have recommended the use of cephalomedullary devices, which offer the following advantages compared to dynamic condylar screws: more efficient load transfer, greater tensile strength, shorter operative time, less blood loss, low infection rate, shorter hospital stay, early return to weight bearing and decreased risk of implant failure.
Longer operative time
“We did find that our operative time was slightly longer [with IMHS compared with other cephalomedullary devices], and this might have been due to the use of this relatively new device at our institute and the fact that the distal locking screws required more time for the longer hip screws,” Chou said.
The study results suggest that treatment of reverse oblique intertrochanteric fractures with IMHS compares favorably to treatment with other cephalomedullary devices. “In conclusion, our experience shows favorable clinical and radiologic outcomes, and fixation failure rates compare well with other series,” Chou stated. – by Thomas M. Springer
Reference:
- Chou D, Taylor A, Boulton C, et al. Reverse oblique intertrochanteric femoral fractures treated with the intramedullary hip screw (IMHS). Paper F286. Presented at the 2010 EFORT Congress. June 2-5, 2010. Madrid.
- Daud Chou can be reached at daud.chou@nuh.nhs.uk.
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