Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate.
OBJECTIVE
To compare outcome between the proximal femoral nail (PFN) and the Medoff sliding plate (MSP) in patients with unstable trochanteric or subtrochanteric fractures.


METHODS
This was a consecutive prospective randomized clinical study. In all, 203 patients admitted to two university hospitals with an unstable trochanteric or a subtrochanteric fracture type were included. Surgery was performed with a short intramedullary nail or a dual-sliding plate device. Follow up visits occurred at 6 weeks, 4 months, and 12 months. Functional outcome was measured by walking ability, rising from a chair, curb test, and additional assessments of abductor strength, pain, living conditions, and complications.


RESULTS
The ability to walk 15 m at 6 weeks was significantly better in the PFN group compared to the MSP group with an odds ratio 2.2 (P = 0.04, 95% confidence limits 1.03-4.67). No statistical difference in walking ability could be found between trochanteric and subtrochanteric fractures. The major complication rate (8% in the PFN group and 4% in the MSP group) did not differ statistically (P = 0.50) but reoperations were more frequent in the PFN group (9%) compared to the MSP group (1%; P < 0.02).


CONCLUSIONS
There were no major differences in functional outcome or major complications between the treatment groups. Reasons other than the operated fracture seem to be equally important in determining the long-term functional ability of the patients in our study. An advantage with the MSP was the lower reoperation rate.
Ekström
Wilhelmina
W
Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institute, Stockholm, Sweden. wilhelmina.ekstrom@karolinska.se
Karlsson-Thur
Charlotte
C
Larsson
Sune
S
Ragnarsson
Björn
B
Alberts
Karl-Akke
KA
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D005684:Gait; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D016896:Treatment Outcome