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Randomized Controlled Trial
. 2014 Jan;38(1):155-61.
doi: 10.1007/s00264-013-2196-7. Epub 2013 Dec 7.

Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur

Ioannis Aktselis  1 , Constantine Kokoroghiannis, Evaggelos Fragkomichalos, Georgios Koundis, Anastasios Deligeorgis, Emmanouil Daskalakis, John Vlamis, Nikolaos Papaioannou
Affiliations
Randomized Controlled Trial

Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur

Ioannis Aktselis et al. Int Orthop. 2014 Jan.

Abstract

Purpose: The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures

Methods: Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) intertrochanteric fracture were randomly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device.

Results: All patients were followed up at one, three, six and 12 months postoperatively, except for nine who died. There was no statistical difference in Parker mobility score between groups. The Gamma nail group had significantly higher Barthel Index and EuroQol-5D (EQ-5D) scores than the AMBI group at 12 months. At the same time, the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group. There were no differences in mortality, radiation time and hospital stay. Duration of the operation, incision length and hip pain occurrence were significantly less in the Gamma nail group.

Conclusions: Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw. Nevertheless, an intramedullary nail seems superior in reconstituting patients to their pre-operative state.

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Figures

Fig. 1
Fig. 1
Patient flow through the trial
Fig. 2
Fig. 2
a Intertrochanteric 31-A2.2 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture of right femur, anteroposterior (AP) X-ray. b AP projection at 1 month postoperatively showing excessive medialisation of the distal fragment (90 %) and possible rotation
See this image and copyright information in PMC

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