title: Intramedullary nails result in more reoperations than sliding hip screws in two-part intertrochanteric fractures.
abstract: BACKGROUND
  Sliding hip screws (SHSs) and intramedullary (IM) nails are well-documented implants for simple two-part intertrochanteric fractures; however, there is no consensus regarding which type of implant is better.
  
  
  OBJECTIVE
  We asked whether patients with simple two-part intertrochanteric fractures treated with IM nailing had (1) a lower reoperation rate and (2) less pain and better quality of life than patients treated with SHSs.
  
  
  METHODS
  We used data from the Norwegian Hip Fracture Register on 7643 operations for simple two-part intertrochanteric fractures (AO/OTA Type A1) treated with an SHS (n=6355) or an IM nail (n=1288) between 2005 and 2010. Kaplan-Meier analysis was used to assess reoperation percentages and a Cox regression model was used to assess the risk of reoperation. Questionnaires regarding pain and quality of life were answered by the patients at 4, 12, and 36 months postoperatively.
  
  
  RESULTS
  We found an increased risk of reoperation after IM nailing within 1 postoperative year: 2.4% and 4.2% for SHS and IM nails, respectively. The difference persisted with time: 4.5% and 7.1% at 3 years. We also found minor differences for pain and quality of life which we judged clinically unimportant.
  
  
  CONCLUSIONS
  Based on our findings and a critical review of the literature, we suggest an SHS is likely the preferred implant for simple two-part intertrochanteric fractures.
  
  
  METHODS
  Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Haukeland University Hospital, and Department of Surgical Sciences, University of Bergen, Jonas Lies Vei 65, 5021, Bergen, Norway. kjell.matre@helse-bergen.no
authors.forename: Kjell
authors.initials: K
authors.lastname: Matre
authors.forename: Leif Ivar
authors.initials: LI
authors.lastname: Havelin
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Gjertsen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Espehaug
authors.forename: Jonas Meling
authors.initials: JM
authors.lastname: Fevang
mesh_terms: D000368:Aged; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D009664:Norway; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome