Clinical Outcomes of Intramedullary and Extramedullary Fixation in Unstable Intertrochanteric Fractures: A Randomized Clinical Trial



Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran


Background: The best method for repairing intertrochanteric fractures is still controversial. The fixation methods include
extramedullary (EM) and intramedullary (IM). Studies that compare IM and EM fixations for unstable hip fractures are
rare. In this study, our goal was to compare the efficacy of EM and IM fixation in treatment of unstable intertrochanteric
Methods: A total of 113 patients with unstable intertrochanteric were randomized in this cohort study between March
2016 and June 2018 in trauma center of Kashani and Alzahra Hospitals, Isfahan, Iran. The patients were followed for a
period of 12 months with sequential clinical and imaging evaluations. Baseline data were recorded at the time of injury.
Radiographs were evaluated immediately post-operatively and at the scheduled follow-up intervals.
Results: A total of 20 of patients were excluded during the study and finally 93 patients (43 males and 50 females)
with mean age of 62.74±16.4 completed the follow-up sessions. Mann-Whitney test indicated a significant difference in
tip-apex distance between the two groups. While the two groups were homogeneous in the baseline LEM score, it was
not significantly different between two groups after 1 and 3 months of surgery as well. However, the LEM score was
significantly higher in IM group after 6 and 12 months of surgery.
Conclusion: According to our findings, IM nails (such as the cephalomedullary nail) afforded more advantages over
EM devices (such as the DHS and DCS) in the treatment of unstable intertrochanteric fractures. Our results indicated
that the final LEM scores as well as the time to union were better in IM fixation group.
Level of evidence: I


Main Subjects