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Comparative Study
. 2011 Apr;82(2):166-70.
doi: 10.3109/17453674.2011.566143. Epub 2011 Mar 24.

Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year

Henrik Palm  1 , Charlotte Lysén, Michael Krasheninnikoff, Kim Holck, Steffen Jacobsen, Peter Gebuhr
Affiliations
Comparative Study

Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year

Henrik Palm et al. Acta Orthop. 2011 Apr.

Abstract

Background and purpose: In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS was not adequate in situations with fragile or fractured lateral femoral walls, where it often led to lack of healing in a maximally telescoped position. We hypothesized that INs would be the superior implant in these specific circumstances.

Methods: We retrospectively examined 311 consecutive patients treated in our department between 2002 and 2008, with either an IN (n = 158) or an SHS (n = 153) mounted on a 4-hole side-plate, for an AO/OTA type 31A1-2 pertrochanteric fracture with a detached greater trochanter. The status of the lesser trochanter was assessed preoperatively and the integrity of the lateral femoral wall, fracture reduction, and position of the implants were assessed postoperatively. Reoperations due to technical failure were recorded for one year postoperatively.

Results: Multivariate logistic regression analysis showed that the groups were similar regarding demographic and biomechanical parameters. The lateral femoral wall was more frequently fractured during SHS implantation (42 patients) than in the IN group (9 patients) (p < 0.001). 6 (4%) of the 158 patients operated with IN had to be reoperated, as compared to 22 (14%) in the SHS group of 153 patients (p = 0.001).

Interpretation: IN had a lower reoperation rate than SHS in these pertrochanteric hip fractures with a detached greater trochanter. IN left more lateral femoral walls intact.

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Figures

Figure 1.
Figure 1.
AO/OTA type-31-A pertrochanteric fractures. 31-A1 fractures are simple, whereas 31-A2 fractures are multifragmentary. Subgroups of 31-A2 pertrochanteric fractures are A2.1 (detachment of the lesser trochanter), A2.2 (several intermediate fragments including detachment of the lesser trochanter), and A2.3 (several intermediate fragments extending more than 1 cm distal to the lesser trochanter). 31-A3 intertrochanteric fractures all have a fracture line through the lateral femoral wall, anatomically defined as the lateral femoral cortex distal to the greater trochanter. (Reprinted, with permission from: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. Fracture and dislocation classification compendium - 2007. J Orthop Trauma 2007; 10 Suppl.)
Figure 2.
Figure 2.
An 82-year-old woman sustained a pertrochanteric hip fracture with a detached greater trochanter.
See this image and copyright information in PMC

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