Intramedullary nails increasing in use despite poorer outcomes, study finds

Database investigation finds nail fixation was associated with significantly more complications.

Although the literature does not support the use of intramedullary nails over plates for intertrochanteric fracture fixation, surgeons have been increasingly using such nails over the past several years, according to a study.

Jeff Anglen, MD, and colleague James Weinstein, DO, investigated the frequency that plates and nails are used for intertrochanteric (IT) fracture fixation in the United States, the regional variations of that use and compared outcomes and complication rates between the two fixation methods.

They presented the study results in a poster at the Orthopaedic Trauma Association meeting.

Using data from the American Board of Orthopaedic Surgery (ABOS) Part II oral exam database, the investigators found that the use of intramedullary nails increased from about 5% of cases in 1999 to almost 70% in 2006. During the same period, the use of plates decreased from close to 100% of cases to just over 30%, according to the study.

Nail fixation was also associated with significantly more complications, including bone fracture, and surgical- and procedural-related complications.

Overall, both plates and nails had a similar total complication rate of about 18%. However, bone fracture and surgical complications occurred in about 1% of nailing cases compared to almost none of plating cases. Procedural complications occurred in about 4% of plating cases compared to about 5% of nailing cases (P<.05).

In addition, patient treated with nailing had significantly worse pain and more deformity, according to the study.

For more information:
Anglen J, Weinstein J. Sliding hip screw or intramedullary nail for IT fracture? Changing patterns of practice. Presented at the 23rd Annual Meeting of the Orthopaedic Trauma Association. Oct. 18-20, 2007. Boston.