Sliding screws seen as low-cost alternative to intramedullary nails for hip fractures
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Key takeaways:
- Sliding screws and intramedullary nails yielded similar 1-year outcomes for the treatment of trochanteric hip fractures.
- Sliding hip screws may be preferred over “costly” intramedullary nails in these patients.
Published results showed use of sliding hip screws may be an acceptable low-cost alternative to intramedullary nails for patients undergoing fixation of trochanteric hip fractures.
Emil H. Schemitsch, MD, and colleagues analyzed 850 patients (mean age of 78.5 years) who underwent surgery for a low-energy trochanteric fracture of the hip between January 2012 and January 2016 with either intramedullary nails (IMN) or sliding hip screws (SHS).
The primary outcome was health-related quality of life as measured by EuroQol-5 D scores, according to the study. Other outcomes included revision surgery, fracture healing, patient mobility, hip function and complications.
At 1 year postoperatively, 304 patients in the IMN group (71.9%) and 317 patients in the SHS group (74.2%) had completed follow-up. Schemitsch and colleagues found no significant differences in EQ-5D scores between either group at 1 year. Researchers also found no significant differences between the groups for any of the secondary outcomes at 1 year. They noted no interactions for fracture stability or previous fracture between the groups.
“Although IMN fixation may offer some benefits surrounding earlier mobility over SHS fixation for certain subgroups of patients (ie, those who are high functioning with unstable fracture types), these data suggest this is not the case for most patients, and that the recent increase in more costly IMN fixation is unwarranted,” the researchers wrote in the study.
Perspective
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Although intertrochanteric hip fractures are one of the more common injuries in orthopedics, there is a lack of conclusive evidence favoring one implant in the treatment of these fractures. In general, cephalomedullary nails are favored for fractures that are considered “unstable.” The problem is the definition of “unstable” is nebulous and controversial. Thus, many surgeons default to using cephalomedullary nails compared with sliding hip screws in fractures that may not require this implant. The downside is the possibility of over-treating these injuries and increasing the cost to the overall health care system.
This research article suggests that both implants are equivalent in terms of clinical function. In general, this is a well conducted study but has its limitations. While including 850 patients is commendable for a study of this type, it may lack statistical power to detect some of their stated outcomes, such as fracture healing. Only 850 of the nearly 4,000 screened patients were randomized, so this limits the generalizability. Overall, this is a well-done study suggesting that cephalomedullary nails are overused; however, the optimal use rate is unclear.
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