title: Cephalomedullary nail versus sliding hip screw for fixation of AO 31 A1/2 intertrochanteric femoral fracture: a 12-year comparison of failure, complications, and mortality.
abstract: BACKGROUND
  In the United States intertrochanteric and pertrochanteric fractures occur at a rate of more than 150,000 cases annually. Current standard of care for these fractures includes fixation with either a cephalomedullary nail (CMN) or a sliding hip screw (SHS). The purpose of this study was to compare failure and medical complications of intertrochanteric femoral fractures repaired by CMN or SHS.
  
  
  METHODS
  This study is a retrospective cohort study that included 249 patients with AO/OTA 31 A1.1-3, 31 A2.1-3 nonpathological fractures of the femur, of which 137 received CMN and 112 received SHS. Analysis was stratified by fracture type as stable (AO 31A1.1-2.1) or unstable (AO 31A2.2-3).
  
  
  RESULTS
  The tip-apex distance in stable fractures fixed with CMN was 17.3 ± 5.9 compared to 26.2 ± 7.9 in the stable SHS group (p<0.001) while it was 19.0 ± 5.3 in the unstable CMN group compared to 24.0 ± 6.7 in the unstable SHS patients (P= 0.004). Among patients with stable fracture patterns there was no difference in collapse, complications, failure, or mortality (allP> 0.05). Among patients with unstable fractures CMN had significantly less collapse (P< 0.001) and failure (P= 0.046) but no difference in complications (P= 0.126) or mortality (P= 0.586).
  
  
  CONCLUSIONS
  There were no significant differences in failure or complication rates when comparing the CMN to the SHS in stable intertrochanteric fractures. CMN demonstrated significantly reduced failure and collapse rates in unstable intertrochanteric fractures when compared to SHS; however, this study had a relatively small sample size of unstable fractures and all results must be interpreted within this context.
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT.
authors.forename: Casey S
authors.initials: CS
authors.lastname: Whale
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT.
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Hulet
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beebe
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT.
authors.forename: David L
authors.initials: DL
authors.lastname: Rothberg
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Chong
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Presson
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT.
authors.forename: Ami R
authors.initials: AR
authors.lastname: Stuart
authors.affiliation: Department of Orthopaedics, University of Utah, Salt Lake City, UT.
authors.forename: Erik N
authors.initials: EN
authors.lastname: Kubiak
keywords: Femur; comparison; stable fracture; treatment; unstable fracture