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Similar reoperation rates seen with long gamma nails and sliding hip screws
The investigators found that the reoperation rate was significantly associated with tip-apex distance.
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DENVER — Research comparing sliding hip screws and long gamma nails for the treatment of unstable pertrochanteric hip fractures shows no significant differences regarding reoperation rates and outcome scores.
In a prospective, randomized study, Timothy J.S. Chesser, FRCS, and colleagues from the United Kingdom examined 210 consecutive patients with unstable pertrochanteric hip fractures who were treated with either sliding hip screws (SHSs) or long gamma nails (LGNs) during a 4-year period.
The investigators found no significant differences between the groups regarding preoperative demographics such as age, gender, mobility and American Society of Anesthesiologists (ASA) grade. However, they discovered that a greater proportion of patients in the LGN group were cognitively impaired, as demonstrated by a mental test score of less than 10.
No significant differences
During the 1-year follow-up, the investigators found an overall reoperation rate of 2.4% and no significant difference in the reoperation rates between the groups. They also found that reoperation was significantly associated with tip apex distance.
In addition, they saw no significant differences between the groups regarding secondary outcomes such as length of hospital stay, need for blood transfusion, change in mobility and change in residence.
“We noted mortality to be significantly higher in the long gamma nail group, but we know that mortality is strongly associated with mental test score,” Chesser said. “When mortality was controlled for mental test score, there was no significant difference between the two groups.”
EuroQol EQ-5D scores available for 88% of the patients also showed no significant differences between the groups.
“There were no significant differences between the two groups with regards to reoperation rates and all secondary outcomes,” Chesser said. “We believe that theoretical biomechanical advantages of intramedullary fixation do not translate into clinical practice in the low demand patients, and the fixation of the sliding hip screw still seems sufficient in osteoporotic bone, despite the longer level arm.”
He added, “We believe that increased use of intramedullary devices for unstable pertrochanteric hip fractures is not justified by clinical evidence. I think that this study emphasizes the importance of the technical procedure including tip apex distance.”
Trends, costs
The study included patients with AO/OTA 31 A2 fractures who were randomized to treatment using a closed envelope randomization method. The LGN group included 100 patients and 110 were in the SHS group. Two patients randomized to the LGN group died preoperatively, Chesser said.
Most patients in the study were ASA grades 2 and 3, and the mean age of the study group was 83 years old.
“There were three reoperations in the long gamma nail group, two reoperations in the sliding hip screw group,” Chesser said.
Although the investigators found no statistically significant differences between the groups regarding the secondary outcomes, Chesser said that the LGN group had more patients transfused and that the SHS group had slightly better EuroQol scores.
While the incidence of periprosthetic fracture has been eliminated with the use of long gamma nails, Chesser noted that sliding hip screws cost much less than long gamma nails.
“We believe that the sliding hip screw remains the gold standard in the treatment of unstable pertrochanteric hip fractures,” he said.
For more information:
- Timothy J.S. Chesser, MD, can be reached at Frenchay Hospital, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE, England; 44-117-970-1212; e-mail: tim.chesser@nbt.nhs.uk. He has received research support from Stryker.
Reference:
- Chesser TJS, Barton TM, Gleeson R, et al. A prospective randomized trial comparing the long gamma nail with the sliding hip screw for the treatment of unstable pertrochanteric hip fractures. Paper #48. Presented at the 24th Annual Meeting of the Orthopaedic Trauma Association. Oct. 16-18, 2008. Denver.