Registry data support sliding hip screws for simple two-part trochanteric fractures

The 1-year reoperation rate was 2.4% with sliding hip screws and 4.2% with intramedullary nails.

Issue: Issue 6 2012

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, here. “My recommendation to you would be that if you are [one] 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 consider not using a nail for these fractures and go back to the sliding hip screw.”

Best fixation method

Matre noted that in the United States more than 90% of these fractures used to be treated with sliding hip screws, and surgeons there have recently switched to using IM nails for them “without any clinical evidence to support this shift in treatment,” he said. “The [research] question was, ‘Which implant is the best?’ Is there a difference whether we treat these patients with a nail or sliding hip screw?”

Simple two-part AO/OTA Type A1 intertrochanteric fractures can be treated with intramedullary (IM) nails or sliding hip screws.

Peri-implant fractures as a problem with femoral fractures has not yet been completely solved, despite using a modern IM nail technique.

Images: Matre K

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.

Survival analysis

Patients in both treatment groups were comparable in regard to gender, age, American Society of Anesthesiologists score, preoperative 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 the Visual Analog Scales for pain and satisfaction.

$The implants used for these “simple” two-part trochanteric fractures — the IM nail and sliding hip screw — are shown in this radiograph.$

The implants used for these “simple” two-part trochanteric fractures — the IM nail and sliding hip screw — are shown in this radiograph.

However, a survival analysis revealed a 1-year reoperation rate of 2.4% for the sliding hip screws vs. 4.2% for IM nails. The reoperation rate at 3 years for the screws was 4.5% compared with 7.1% for the IM nail group, according to the study. – by Gina Brockenbrough, MA

Reference:

Matre K. Paper #27. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 3-6, 2012; Minneapolis.

For more information:

Kjell Matre, MD, is head of orthopaedic trauma at Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway; email: kjell.matre@helse-bergen.no.
Disclosure: The Norwegian Hip Fracture Register is financed entirely by the Regional Health Board of Western Norway.