title: Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study.
abstract: We investigated whether a proximal femoral nail can be implanted without a distal locking screw in AO/OTA 31-A1 and 31-A2 pertrochanteric stable femur fractures. A multicentre, randomised study was conducted in six level-two trauma centres in our area (Puglia, Italy). A total of 333 patients received their allocated intervention (162 in the locking group [LG] and 171 in the unlocking group [UG]) and 266 patients were included in the final analysis at 1year. Our data showed no statistically significant difference between the two groups at 1-year follow-up for ability to walk, SF-36 questionnaire results, residual pain (visual analogue scale [VAS] score) and level of overall satisfaction. There were also no statistically significant differences between groups for mortality and length of hospital stay. Conversely, the UG was associated with shorter operation and fluoroscopy times, shorter surgical incision length, and less blood loss and residual thigh pain. Pertrochanteric stable fractures (31-A1, 31-A2) can be treated successfully with intramedullary nails without distal locking, reducing patient and clinical personnel radiation exposure and sanitary costs (surgery time and screws costs).
authors: Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari Italy.
authors: V
authors: V
authors: Caiaffa
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy. Electronic address: dott.gvicenti@gmail.com.
authors: G
authors: G
authors: Vicenti
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: C
authors: C
authors: Mori
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: A
authors: A
authors: Panella
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: V
authors: V
authors: Conserva
authors: Department of Orthopaedics and Traumatology, Dario Camberlingo Hospital, Francavilla Fontana Italy.
authors: G
authors: G
authors: Corina
authors: Department of Orthopaedics and Traumatology, SS Annunziata Hospital, Taranto Italy.
authors: L
authors: L
authors: Scialpi
authors: Department of Orthopaedics and Traumatology, Monsignor Raffaele Dimiccoli Hospital, Barletta Italy.
authors: A
authors: A
authors: Abate
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: M
authors: M
authors: Carrozzo
authors: Department of Orthopaedics and Traumatology, San Paolo Hospital, Bari Italy.
authors: Leonardo
authors: L
authors: Petrelli
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: G
authors: G
authors: Picca
authors: Department of Orthopaedics and Traumatology, Santa Caterina Novella Hospital, Galatina Italy.
authors: A
authors: A
authors: Aloisi
authors: Department of Orthopaedics and Traumatology, Vito Fazi Hospital, Lecce Italy.
authors: G
authors: G
authors: Rollo
authors: Department of Orthopaedics and Traumatology, Vito Fazi Hospital, Lecce Italy.
authors: M
authors: M
authors: Filipponi
authors: Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari Italy.
authors: V
authors: V
authors: Freda
authors: Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari Italy.
authors: A
authors: A
authors: Pansini
authors: Department of Orthopaedics and Traumatology, Francesco Ferrari, Casarano Italy, Italy.
authors: A
authors: A
authors: Puce
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: G
authors: G
authors: Solarino
authors: Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy.
authors: B
authors: B
authors: Moretti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005471:Fluoroscopy; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D061646:Operative Time; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome
keywords: Complications; Distal locking; Intramedullary nail; Pertrochanteric fractures