Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation?
This study was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized using a sliding hip screw or an intramedullary nail. A 20% sample of Part A and B entitled Medicare beneficiaries 65 years or older was used to generate a cohort of patients who sustained intertrochanteric femur fractures between 1999 and 2001. Two fracture implant groups, intramedullary nail and sliding hip screw, were identified using Current Procedural Terminology and International Classification of Diseases, 9th Revision codes. The cohort consisted of 43,659 patients. Patients treated with an intramedullary nail had higher rates of revision surgery during the first year than those treated with a sliding hip screw (7.2% intramedullary nail versus 5.5% sliding hip screw). Mortality rates at 30 days (14.2% intramedullary nail versus 15.8% sliding hip screw) and 1 year (30.7% intramedullary nail versus 32.5% sliding hip screw) were similar. Adjusted secondary outcome measures showed significant increases in the intramedullary nail group relative to the sliding hip screw group for index hospital length of stay, days of rehabilitation services in the first 6 months after discharge, and total expenditures for doctor and hospital services.


METHODS
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Aros
Brian
B
Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, NH, USA.
Tosteson
Anna N A
AN
Gottlieb
Daniel J
DJ
Koval
Kenneth J
KJ
D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome