title: Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year.
abstract: OBJECTIVE
  In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS was not adequate in situations with fragile or fractured lateral femoral walls, where it often led to lack of healing in a maximally telescoped position. We hypothesized that INs would be the superior implant in these specific circumstances.
  
  
  METHODS
  We retrospectively examined 311 consecutive patients treated in our department between 2002 and 2008, with either an IN (n = 158) or an SHS (n = 153) mounted on a 4-hole side-plate, for an AO/OTA type 31A1-2 pertrochanteric fracture with a detached greater trochanter. The status of the lesser trochanter was assessed preoperatively and the integrity of the lateral femoral wall, fracture reduction, and position of the implants were assessed postoperatively. Reoperations due to technical failure were recorded for one year postoperatively.
  
  
  RESULTS
  Multivariate logistic regression analysis showed that the groups were similar regarding demographic and biomechanical parameters. The lateral femoral wall was more frequently fractured during SHS implantation (42 patients) than in the IN group (9 patients) (p < 0.001). 6 (4%) of the 158 patients operated with IN had to be reoperated, as compared to 22 (14%) in the SHS group of 153 patients (p = 0.001).
  
  
  CONCLUSIONS
  IN had a lower reoperation rate than SHS in these pertrochanteric hip fractures with a detached greater trochanter. IN left more lateral femoral walls intact.
authors: Department of Orthopaedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark. hpalm@dadlnet.dk
authors: Henrik
authors: H
authors: Palm
authors: Charlotte
authors: C
authors: Lysén
authors: Michael
authors: M
authors: Krasheninnikoff
authors: Kim
authors: K
authors: Holck
authors: Steffen
authors: S
authors: Jacobsen
authors: Peter
authors: P
authors: Gebuhr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors