Mini-invasive nail versus DHS to fix pertrochanteric fractures: a case-control study.
BACKGROUND
Fixation devices to treat trochanteric fractures belong to two general categories: dynamic hip screw (DHS) type and intramedullary type implants. In spite of possible pitfalls, both are considered valid options. Comparing a sliding screw-plate system (DHS) along a mini-invasive nailing device (BCM nail) with primary insertion of the cephalic screw, sheds light on the debated management of trochanteric fractures.


OBJECTIVE
Due to its design, the BCM nailing system allows a stable internal fixation and promotes enhanced postoperative functional recovery.


OBJECTIVE
To test this hypothesis in a comparative prospective case-control study using the DHS screw-plate as a reference.


METHODS
Two groups of 30 patients, older than 60 years old, with trochanteric fractures were included in this study. The screw-plates were placed according to the standard method. Regarding the nailing system, the cephalic screw was positioned first, then the nail was inserted through the screw via a mini-invasive approach and locked distally using a bicortical screw. Comparison between the two groups was based on (1) operative data: operating time, intra- and postoperative blood loss; (2) immediate postoperative course: complications, length of hospital stay, delay to sitting in a wheelchair; (3) the postdischarge evolution: weightbearing, readmission to hospital; (4) functional outcomes: recovery and mobility; (5) anatomical outcomes: restitution and bone healing.


RESULTS
The operating time (54+/-8.8 min vs 59+/-13.8 min) and intraoperative (1.37+/-0.98 vs 1.90+/-1.43) and at Day 3 (1.25+/-1.05 vs 1.82+/-1.5) blood loss (haemoglobin loss), were favourable to the screw-plate subgroup (p<0.05). The delay to sitting in a wheelchair (4.76+/-1.53 d vs 4+/-1.44 d) was favourable to the nail subgroup (p<0.05). There was a higher incidence of secondary displacements in the screw-plate subgroup (3/26 [11.5%] vs 0/25 [0%]) (p<0.05). The screw-plate subgroup demonstrated a poorer healing rate at 3 months (88% vs 100%) (p<0.05). Regarding functional recovery, a lesser decrease in the Parker score was observed in the nail subgroup at 3 postoperative months (2.42+/-2.3 vs 1.52+/-1.44) (p<0.05).


CONCLUSIONS
This study has shown the benefits of the BCM nail in terms of stability. But the potential advantages of this mini-invasive technique were limited by ancillary-related difficulties which need to be rectified. These preliminary results are in favour of a further development of this innovating device.
Foulongne
E
E
Department of Orthopaedic and Trauma Surgery, Charles Nicolle Hospital, Rouen University Hospital Center, 76031 Rouen cedex, France.
Gilleron
M
M
Roussignol
X
X
Lenoble
E
E
Dujardin
F
F
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D017102:Fracture Healing / Q000502:physiology; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome