Systematic effects of surgical treatment of hip fractures: gliding screw-plating vs intramedullary nailing.
OBJECTIVE
Numerous studies have been published regarding the comparison between intramedullary nail and the dynamic hip screw and plate for the fixation of intertrochanteric fractures in elderly patients. In this paper we present a comparative study of these two methods regarding their systemic effects on this group of patients.


METHODS
This is a randomized trial of 120 consecutive patients with an intertrochanteric fracture treated with either extramedullary fixation (dynamic hip screw and plate; DHS, Synthes-Stratec, Oberdorf, Switzerland) or intramedullary nail (Gamma nail, Stryker Howmedica, Freiburg, Germany and Endovis BA, Citieffe, Bologna, Italy). The parameters that we assessed pre-operatively, in addition to their demographics, included their mental state (MMSE), their nutritional and immune state and their pulmonary function. Intra-operatively we calculated the amount of radiation exposure, the amount of blood loss and the length of operative time for each procedure. Postoperatively we repeated the calculation of the mental and pulmonary state and the blood loss, during days 1, 3, and 10 and related them to the ease of the patient's mobilization.


RESULTS
Decreased bleeding and post-operative pain, reduced post-operative morbidity and faster recovery of function were better but not significant in the group of intramedullary fixation (all p>0.05). However, in the same group there were slightly more patients in whom the MMSE was falling, together with their pulmonary function, suggesting that this method probably predisposes to higher chances of pulmonary dysfunction and the possibility of pulmonary embolism.


CONCLUSIONS
We found no significant differences between the two methods of stabilization of these fractures regarding their systemic effects perioperatively. The classic dynamic hip screw can preserve its position as a safe and effective solution for these already vulnerable patients having sustained a trochanteric fracture against the novel intramedullary techniques.
Verettas
Dionysios-Alexandros J
DA
Department of Orthopaedic Surgery, Democritus University of Thrace, Medical School, University General Hospital of Alexandroupolis, Alexandroupolis, Greece. dveretta@med.duth.gr
Ifantidis
Panos
P
Chatzipapas
Christos N
CN
Drosos
Georgios I
GI
Xarchas
Konstantinos C
KC
Chloropoulou
Pelagia
P
Kazakos
Konstantinos I
KI
Trypsianis
Gregory
G
Ververidis
Athanasios
A
D000368:Aged; D000704:Analysis of Variance; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007361:Intelligence Tests; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D010100:Oxygen / Q000008:administration & dosage / Q000032:analysis; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome
D010100:Oxygen