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Registry data supports sliding hip screws for simple two part trochanteric fractures
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MINNEAPOLIS — Although data for 7,643 AO/OTA type A1 trochanteric fractures treated with either intramedullary nails or sliding hip screws reported in the Norwegian Hip Fracture Registry showed similar patient-reported outcomes for pain, satisfaction and quality of life, investigators discovered significantly more reoperations with nails.
“The patient-reported outcome measures are similar for these two implants, but the reoperation rates were significantly higher after [intramedullary] IM nailing [using] the modern implants,” Kjell Matre, MD, said during his presentation at the Orthopaedic Trauma Association Annual Meeting 2012 here. “My recommendation to you would be that if you are of the rare surgeons who still use the sliding hip screws in these fractures, [then] you should continue to do so. If you do like most of you do, [then] you should stop using a nail for these fractures and go back to the sliding hip screw.”
Kjell Matre
Matre and colleagues from the Orthopaedic Department at Haukeland University Hospital, Bergen, Norway, studied cases of simple, two-part trochanteric fractures treated with either procedure and recorded in the nation’s hip fracture registry, which was created in 2005.
Patients in both treatment groups were comparable with regards to gender, age, American Society of Anesthesiologists score, quality of life, surgical time and distribution of those with cognitive impairments, Matre said. Follow-up at 4 months, 1 year and 3 years showed no significant differences between the groups at any time points using the EuroQol-5D, and Visual Analog Scales for pain and satisfaction.
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However, a survival analysis revealed a 1-year reoperation rate of 2.4% for the sliding hip screws vs. a 4.2% rate for IM nails. The reoperation rate at 3 years for the sliding hip screws was 4.5% compared with 7.1% for the IM nail group, according to the study abstract.
Reference:
Matre K, Havelin LI, Gjertsen J-E, et al. More reoperations after intramedullary nailing compared with sliding hip screws in the treatment of AO/OTA type A1 trochanteric fractures: Results after 7,643 operations reported to the Norwegian Hip Fracture Register. Paper #27. Presented at the Orthopaedic Trauma Association Annual Meeting 2012. Oct. 3-6. Minneapolis.
Disclosure: Matre receives research support from Smith & Nephew as a principle investigator.
