Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail.
OBJECTIVE
To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures.


METHODS
Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1; n = 106) and those treated by intramedullary nailing (Group 2; n = 100).


METHODS
University Level I trauma center.


METHODS
All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA Type 31-A1 and A2.


METHODS
Treatment with a sliding compression hip screw (Dynamic Hip Screw; Synthes-Stratec, Oberdorf, Switzerland) or an intramedullary nail (Proximal Femoral Nail; Synthes-Stratec, Oberdorf, Switzerland).


METHODS
Intraoperative: operative and fluoroscopy times, the difficulty of the operation, intraoperative complications, and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score.


RESULTS
The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively, radiologically, or clinically, between the two groups of patients.


CONCLUSIONS
There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.
Saudan
Marc
M
Clinique d'Orthopédie et de Chirurgie de l'Appareil Moteur, Hôpital Cantonal Universitaire, Geneva, Switzerland.
Lübbeke
Anne
A
Sadowski
Christophe
C
Riand
Nicolas
N
Stern
Richard
R
Hoffmeyer
Pierre
P
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D004867:Equipment Design; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies