Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures.

ABSTRACT

BACKGROUND: Sliding hip screws (SHSs) and intramedullary (IM) nails are well-documented implants for simple two-part intertrochanteric fractures; however, there is no consensus regarding which type of implant is better. QUESTIONS/PURPOSES: We asked whether patients with simple two-part intertrochanteric fractures treated with IM nailing had (1) a lower reoperation rate and (2) less pain and better quality of life than patients treated with SHSs. METHODS: We used data from the Norwegian Hip Fracture Register on 7643 operations for simple two-part intertrochanteric fractures (AO/OTA Type A1) treated with an SHS (n=6355) or an IM nail (n=1288) between 2005 and 2010. Kaplan-Meier analysis was used to assess reoperation percentages and a Cox regression model was used to assess the risk of reoperation. Questionnaires regarding pain and quality of life were answered by the patients at 4, 12, and 36 months postoperatively. RESULTS: We found an increased risk of reoperation after IM nailing within 1 postoperative year 2.4% and 4.2% for SHS and IM nails, respectively. The difference persisted with time 4.5% and 7.1% at 3 years. We also found minor differences for pain and quality of life which we judged clinically unimportant. CONCLUSIONS: Based on our findings and a critical review of the literature, we suggest an SHS is likely the preferred implant for simple two-part intertrochanteric fractures. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.