Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilization of intertrochanteric fractures. A prospective randomized study

Abstract

This study is a randomized prospective study comparing two fracture fixation implants, the extramedullary sliding hip screw (SHS) and the dual lag screw cephalomedullary nail, in the treatment of intertrochanteric femoral fractures in the elderly. One hundred and sixty-five patients with low-energy intertrochanteric fractures, classified as AO/OTA 31A, were prospectively included during a 2-year period (2005-2006). Patients were randomized into two groups: group A included 79 hip fractures managed with sliding hip screws and group B included 86 fractures treated with cephalomedullary nails. Delay to surgery, duration of surgery, time of fluoroscopy, total hospital stay, implant-related complications, transfusion requirements, re-operation details, functional recovery, and mortality were recorded. The mean follow-up was 36 months (24-56 months). The mean surgical time was statistically significantly shorter and fluoroscopy time longer for the group B. No intraoperative femoral shaft fractures occurred. There was no statistically significant difference in the functional recovery score, reoperation, and mortality rates between the 2 groups. A new type of complication, the so-called Z-effect phenomenon, was noticed in the cephalomedullary nail group. There are no statistically significant differences between the two techniques in terms of type and rate of complications, functional outcome, reoperation and mortality rates when comparing the SHS and the cephalomedullary nail for low-energy AO/OTA 31A intertrochanteric fractures. Our data do not support recommendations for the use of one implant over the other.

Fig. 1

Showing the number of patients enrolled and randomized to the study, the drop outs, and the total number of patients that were followed up

Fig. 2

Placement of the distal cephalic lag screw below the midline of the femoral neck, close to or even onto the medial cortex so that the proximal screw will be placed in the center of the head in anteroposterior (a) and lateral (b) images

Fig. 3

X-ray image showing a typical fracture with acceptable closed reduction, which eventually showed radiographically evident healing at the 4-month postoperative visit

Fig. 4

Cutout of the sliding hip screw, which was revised using a new SHS 3 months after the initial operation

Fig. 5

X-ray showing the barrel-plate pulled off the femur as a result of a fall 4 months postoperatively

Fig. 6

X-ray showing a case in which distal locking screws were missed. The screws left in place and the postoperative protocol were followed as usual without any further complication

Fig. 7

Charts showing the patients’ rate for each group that reached more than 90, 75–90, 60–75, and 0–60 % of the pre-fracture mobility level at 1 year postoperatively