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Intramedullary nails outperformed sliding hip screws in transtrochanteric fracture investigation
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A British investigator reported that intramedullary nailing produced better results than sliding hip screws for fixation of difficult transtrochanteric fractures of the proximal femur.
“There is possibly a trend toward better results with the nail — slightly less pain and better regain of function,” Martyn Parker, MD, FRCS, said during the presentation of his study at the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congress 2010.
Parker’s study included 53 patients with fractures of the proximal femur at the level of the lesser trochanter, according to his abstract. Patients were randomized for fixation method: 27 patients underwent intramedullary (IM) nailing and 26 received sliding hip screws. A nurse who was blinded to the treatment groups observed the patients for 1 year following the procedure.
Pain and mobility
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Patients treated with IM reported significantly lower pain scores than those treated with sliding hip screws (P<.0001). This difference persisted at 1-year follow-up, Parker noted.
Additionally, Parker stated, “There was a tendency to better regain mobility with the nail, although the difference was not statistically significant.”
According to the study abstract, one operative complication occurred in the intramedullary nail group, compared with five in the sliding hip screw group. Average hospital stay was 17 days in the IM nail group, compared with 29 in the sliding hip screw group.
Similar results, surgeon preference
Parker reported no differences between the groups for operative time, blood transfusion rates, wound infection, mortality, anatomical restoration and fracture-healing complications.
“So in summary, both the sliding hip screw and the intramedullary nail did achieve acceptable results for the treatment of this difficult fracture,” Parker said. “Surgeons should choose, therefore, which they think would work best in their hands and which they have the most experience.”
- Reference:
Parker M. Intramedullary versus extramedullary fixation for transtrochanteric fractures of the proximal femur: a randomised trial. Paper F285. Presented at the 2010 EFORT Congress. June 2-5, 2010. Madrid.
Martyn Parker, MD, FRCS, can be reached at 1 Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, United Kingdom; e-mail: dandmparker@tiscali.co.uk.
