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Study supports use of sliding hip screws for stable peritrochanteric hip fractures

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SAN FRANCISCO — The results of a retrospective review validated a protocol in which orthopedic trauma surgeons used sliding hip screws for stable peritrochanteric hip fractures and treated unstable fractures with cephallomedullary nails.

“We have shown that fractures can be reliably classified as either stable or unstable such that implant choice resulted in predictable healing,” Thomas W. Axelrad, MD, PhD, said during his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. “Use of the sliding hip screws also resulted in significant cost savings to our hospital, with savings of over $100,000 during the course of our study. [Sliding] hip screws may be preferable for stable fractures as their use results in reduced costs and shorter operative times compared to long intramedullary nails.”

Axelrad and colleagues studied the records of 121 patients with peritrochanteric hip fractures who were treated by the two senior authors of the study. Using the medial or subtrochanteric extension and the condition of the lateral wall to determine fracture stability, surgeons treated stable fractures with sliding hip screws and unstable fractures with intramedullary nails. The fractures were re-assessed by a blinded, independent reviewer using the Evans classification to determine stability.

“In general, the re-assessment of the fractures was consistent with the proposed protocol with most stable fractures receiving sliding hip screws and those patients with unstable fractures being treated with cephallomedullary nails,” Axelrad said.

The investigators used postoperative radiographs to measure the tip-apex distance, and determined shortening of the neck-shaft angle using initial postoperative and final follow-up radiographs.

“Operative time was significantly longer for the intramedullary nails,” Axelrad said. “However, there was no difference [between groups] in the transfusion requirements or duration of hospital stay.”

The sliding hip screw group had a slightly less tip-apex distance than the nail group, but investigators found no significant difference between the groups for femoral shortening.

“Neither group lost reduction, although reduction was slightly more anatomic for the sliding hip screws with the difference being statistically significant,” Axelrad said.

The investigators found two cases of screw cut out. Three patients in the nail group had a nonunion, and these cases had subtrochanteric extension.

Reference:

• Tornetta P, Axelrad TW, DeHaan A, Creevy WR. The orthopaedic traumatologist and the peritrochanteric hip fracture — Does experience matter? Paper #146. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
• Disclosure: Axelrad receives royalties, financial or material support from Wolters Kluwer Health Lippincott Williams & Wilkins.

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