title: Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis.
abstract: BACKGROUND
  The best options of internal fixation for unstable intertrochanteric femoral fractures in elderly osteoporotic patients remain controversial. We determined whether intramedullary nail or extramedullary plate provides better treatment for unstable intertrochanteric fractures using a decision analysis tool that considers quality of life.
  
  
  METHODS
  A decision analysis model was constructed containing final outcome score and the probability of mortality within 1 year, infection, and mechanical complications. Final outcome was defined as health-related quality of life and was used as a utility in the decision tree. Probabilities were obtained by literature review, and health-related quality of life was evaluated by asking 30 orthopedic experts to complete a questionnaire. A roll back tool was used to determine the best surgical option, and sensitivity analysis was performed to compensate for decision model uncertainty.
  
  
  RESULTS
  The decision model favored intramedullary nailing in terms of quality of life. In one-way sensitivity analysis, intramedullary nailing was more beneficial than the extramedullary plating, when probability of mechanical complication after intramedullary nailing was below 0.258.
  
  
  CONCLUSIONS
  In terms of quality of life, the decision analysis model showed that intramedullary nailing was more beneficial for patients with an unstable intertrochanteric fracture.
authors: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
authors: Young-Kyun
authors: YK
authors: Lee
authors: Chin Youb
authors: CY
authors: Chung
authors: Moon Seok
authors: MS
authors: Park
authors: Kyoung Min
authors: KM
authors: Lee
authors: Kyung-Hoi
authors: KH
authors: Koo
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D003661:Decision Support Techniques; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D005594:Fracture Fixation, Intramedullary; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome