title: Femoral Medialization, Fixation Failures, and Functional Outcome in Trochanteric Hip Fractures Treated With Either a Sliding Hip Screw or an Intramedullary Nail From Within a Randomized Trial.
abstract: OBJECTIVE
  The aim of this study was to determine if femoral medialization influences residual pain and mobility and to determine if fixation method or fracture pattern influences the tendency to medialize.
  
  
  METHODS
  This study used data from within a randomized controlled trial.
  
  
  METHODS
  Peterborough City Hospital, UK.
  
  
  METHODS
  Eight hundred forty-four patients presenting with a trochanteric hip fracture were randomized. Five hundred thirty-eight were available for 1-year follow-up. Fractures were classified according to OTA/AO classification as 31 A1, A2, and A3.
  
  
  METHODS
  Randomized to fixation with a Targon proximal femoral nail or sliding hip screw (SHS).
  
  
  METHODS
  Femoral medialization was calculated from follow-up x-rays at a minimum of 28 days post-fixation. Pain and mobility scores were assessed at 1 year by an independent blinded observer. Fixation failure and revision procedures were assessed at a minimum of 1 year from injury.
  
  
  RESULTS
  Patients with >50% medialization had worse pain (P = 0.012) and mobility scores (P = 0.013) at 1 year. They also had more fracture healing complications (P = 0.021) and required more revision procedures (P = 0.014). Fractures treated with SHS were more likely to medialize >50% compared with intramedullary nail (P < 0.001). A2 and A3 fractures were more likely to medialize, and A3 fractures were more likely to undergo >50% medialization (P < 0.001).
  
  
  CONCLUSIONS
  Our study demonstrates the previously theoretical predisposition for unstable hip fractures treated with SHS to undergo femoral medialization and correlates this with worse functional outcomes. It supports the use of intramedullary nails for A3 fractures, which have a significant tendency to medialize.
  
  
  METHODS
  Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom; and†Department of Orthopaedic, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Bretherton
authors.forename: Martyn J
authors.initials: MJ
authors.lastname: Parker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws / Q000706:statistics & numerical data*; D005260:Female; D005269:Femur / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data*; D018570:Risk Assessment; D017211:Treatment Failure; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology