Hip plating system yielded similar quality of life outcomes vs sliding hip screw
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Patients with trochanteric hip fractures treated with a hip plating system had similar health-related quality of life outcomes and risk of revision as those treated with a sliding hip screw, according to published results.
Researchers randomly assigned 1,128 patients with a trochanteric hip fracture to fracture fixation with either a sliding hip screw (n=564) or the X-Bolt Dynamic Hip Plating System (n=564; X-Bolt Orthopaedics). Researchers assessed the EuroQol-5D-5L at 4 months postoperatively as the primary outcome, while EQ-5D-5L utility at 12 months, mortality, residential status, mobility, revision surgery and radiological measures were considered the secondary outcomes.
In the primary intention-to-treat analysis, researchers analyzed 437 patients in the hip plating system group and 443 patients in the sliding hip screw group. Results showed the adjusted utility index had a mean difference of 0.029 in favor of the hip plating system with no difference between the groups. Researchers found no differences in any of the secondary outcomes between the treatment groups. The hip plating and sliding hip screw groups also had similar pattern and overall risk of adverse events, according to results.
“This was a large trial in a frail patient group, whose main desire is to stay out of hospital and to maintain their independence,” Brian Thornes, MD, MS, FRCSI, CEO of X-Bolt Orthopaedics, said in a company press release. “The data confirms the outstanding safety profile of the X-Bolt, which virtually eliminates ‘cut out’ as an issue. I am also delighted that the clinical impact translates into intangibly better outcomes for a significant number of patients.”
Reference:
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This 1,000-plus patient, randomized controlled trial of intertrochanteric hip fractures reminds surgeons that how you do the surgery and where you place the implants matters more than which implant you choose. This study joins a long line of large, well done, intertrochanteric fracture randomized controlled trials which showed no difference in outcome. Surgeons can choose nails or hip screws, long or short nails — it has little influence. The most important things are good reduction, small tip-apex distance and early mobilization.
Three pearls are buried in these data: The researchers noted that surgical complications seem to be going down because hip fracture cases are being done in daytime trauma block. Also, they are going to publish a separate paper on radiographic outcomes — interesting, because we know that maintenance of length (avoiding shortening) is associated with better function. Finally, there is a persistently high 35% mortality rate at 1 year.
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