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

2 Department of Orthopedic, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Orthopedic Surgery Department, Alzahra Educational Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.


Introduction: The best method for repairing intertrochanteric fractures is still controversial. These include extramedullary (EM) and intramedullary (IM) fixation. Studies that compare IM and EM fixations for unstable hip fractures are rare. In this study, our goal was to compare efficacy of EM and IM fixation in treatment of unstable intertrochanteric fractures.

Methods and materials: This cohort study conducted from March 2016 to June 2018 in trauma center of Kashani and Alzahra Hospitals, Isfahan, Iran. Patients with unstable intertrochanteric femoral fractures were randomized to compare two different treatment methods. The patients were followed for a period of 12 months with sequential clinical and imaging evaluations. Baseline data were registered at the time of injury. Radiographs were evaluated immediately post-operatively and at the scheduled follow-up intervals.

Results: A total of 113 patients with unstable intertrochanteric were assessed, however, 20 0f them excluded during the study. (Figure-1) Finally 93 patients (43 males and 50 females) with mean age of 62.74±16.4 completed the follow-up sessions of the study. Mann-Whitney test indicated that there was a significant difference of tip-apex distance between the two groups. T-test revealed that there was no significant difference between two groups in baseline LEM score. Also, LEM score was not significantly different between two groups after 1 and 3 months of surgery. However, it was significantly higher in IM group after 6 and 12 months of surgery.

Conclusion: It was concluded that IM nails (such as the cephalomedullary nail) afforded more advantages over EM devices (such as the DHS and DCS) in treatment of unstable intertrochanteric fractures and our data indicated that the final LEM scores and the times to union were better in IM fixation group.


Main Subjects