title: Do intramedullary implants improve survival in elderly patients with trochanteric fractures? A retrospective study.
abstract: There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws.
  
  
  
  Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records.
  
  
  
  The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs.
  
  
  
  A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.
authors.affiliation: Department of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes', Timişoara, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Vermesan
authors.affiliation: Department of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes', Timişoara, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Prejbeanu
authors.affiliation: Department of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes', Timişoara, Romania.
authors.forename: D V
authors.initials: DV
authors.lastname: Poenaru
authors.affiliation: Department of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes', Timişoara, Romania.
authors.forename: H
authors.initials: H
authors.lastname: Petrescu
authors.affiliation: West University 'Vasile Goldis', Arad, Romania.
authors.forename: E
authors.initials: E
authors.lastname: Apostol
authors.affiliation: Department of Interdisciplinary Medicine, Medical School, University of Bari.
authors.forename: F
authors.initials: F
authors.lastname: Inchingolo
authors.affiliation: Department of Interdisciplinary Medicine, Medical School, University of Bari.
authors.forename: G
authors.initials: G
authors.lastname: Dipalma
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Medical School, University of Bari.
authors.forename: A
authors.initials: A
authors.lastname: Abbinante
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Medical School, University of Bari.
authors.forename: M
authors.initials: M
authors.lastname: Caprio
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Medical School, University of Bari.
authors.forename: M A
authors.initials: MA
authors.lastname: Potenza
authors.affiliation: Department of Biomedical Sciences and Human Oncology, Medical School, University of Bari.
authors.forename: R
authors.initials: R
authors.lastname: Cagiano
authors.affiliation: Medical School, University of Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Malcangi
authors.affiliation: Medical School, University of Bari, Italy.
authors.forename: A D
authors.initials: AD
authors.lastname: Inchingolo
authors.affiliation: Department of Orthopedics and Trauma, University of Medicine and Pharmacy 'Victor Babes', Timişoara, Romania.
authors.forename: H
authors.initials: H
authors.lastname: Haragus
mesh_terms: D001858:Bone Nails; D001863:Bone Screws; D005594:Fracture Fixation, Intramedullary / Q000379:methods* / Q000401:mortality; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D012189:Retrospective Studies
keywords: Dynamic hip screw; Gamma nail; Hip fracture; Mortality; Survival