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Findings suggest IM nails help minimize pain associated with some trochanteric hip fractures
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Investigators reported femoral medialization of trochanteric hip fractures tended to occur more often in AO type A2 and A3 fractures. Medialization that exceeded 50% was more likely to occur in the type A3 fractures assessed in this study, which used data from a randomized controlled trial.
Among 844 patients who presented with a trochanteric hip fracture, 538 patients were randomized and available for follow-up at 1 year. In all, 266 patients were treated with a Taragon proximal femoral intramedullary nail (BBrawn) and 272 patients were treated with a sliding hip screw (Corin PLC). Investigators used radiographs to assess the extent of any medialization, which was defined as medial displacement of the femoral shaft. They determined mobility in all 538 patients and pain in 510 patients. All patients underwent unrestricted early postoperative mobilization.
In a follow-up phone call, a nurse who was blinded the treatment the patients received assessed them for mobility and pain. The patients with fracture medialization that exceeded 50% had worse pain on the Charnley scale than patients with less medialization.
Overall, the mean medialization in the study was 6.4%. Mean medialization was statistically significantly different by treatment type at 10.9% for sliding hip screws and 2% for nails.
“We recommend that future trials comparing intramedullary and extramedullary devices for trochanteric hip fractures exclude A3 fracture and examine unstable A2 fracture patterns as a separate group from the 2-part A1 fractures,” the investigators wrote. – by Susan M. Rapp
Disclosures: No external funding was received for this study. Internal funding was from the Peterborough Hospital Hip Fracture fund. Please see the full study for all the authors’ relevant financial disclosures.
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