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. 2024 Feb;34(2):1193-1199.
doi: 10.1007/s00590-023-03779-5. Epub 2023 Nov 26.

Comparison of intra-operative outcomes following internal fixation with trochanteric stabilisation plate or intramedullary nail in intertrochanteric fractures

Rahul Geetala  1   2 , Edward Wakefield  3   4 , Florence Bradshaw  3   4 , James Zhang  3   4 , Matija Krkovic  4
Affiliations

Comparison of intra-operative outcomes following internal fixation with trochanteric stabilisation plate or intramedullary nail in intertrochanteric fractures

Rahul Geetala et al. Eur J Orthop Surg Traumatol. 2024 Feb.

Abstract

Purpose: Intertrochanteric fractures can be classified as stable (AO-OTA 31-A1) or unstable (AO-OTA 31-A2/3). For A3 fractures there is no recommended treatment, often fixed with either an intramedullary nail (IMN) or a dynamic hip screw and trochanteric stabilisation plate (DHS/TSP). This study retrospectively reviews peri-operative outcomes of patients treated with either fixator.

Methods: Pre-operative demographics, operative information and patient outcome data from 213 patients who suffered intertrochanteric fractures and were treated with either DHS/TSP or IMN at a major trauma centre from 01/2015 to 01/2022 was collected. Unpaired T tests were performed to assess levels of significance between peri-operative outcomes.

Results: The mean age for DHS/TSP-treated patients was 2.63 years greater than IMN-treated (P = 0.039). There were no other significant differences in pre-operative characteristics. We found a significantly shorter mean operative time in the DHS/TSP group (88.05 min, 95% CI: 82.1-94.0) compared to IMN counterparts (100.8 min, 95% CI: 92.7-109.0, P = 0.012), but no statistically significant difference in length of hospital stay or patient mortality, blood transfusion, re-operation or complication rates. When A3 fractures were analysed, a statistically significant greater proportion of IMN patients required blood transfusions (DHS/TSP: 35.90%, IMN: 65.00%, P = 0.0093). All other factors were found to have no significant differences.

Conclusion: This study provides evidence to support the national guidelines regarding A1 fractures and suggests that DHS/TSP is a valid alternative to the IMN in A3 intertrochanteric fractures, with reduced blood loss. With the flexibility to add the TSP intraoperatively to prevent femoral head medialisation, and cheaper implant costs, the DHS/TSP may become the preferred method of internal fixation.

Keywords: Internal fixation; Intertrochanteric fracture; Intramedullary nail; Trochanteric stabilisation plate.

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Conflict of interest statement

The authors have not disclosed any competing interests.

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