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

Document Type : RESEARCH PAPER

Authors

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

Abstract

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
fractures.
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

Keywords

Main Subjects

References

1. Matre K, Havelin LI, Gjertsen JE, Vinje T, Espehaug B,
Fevang JM. Sliding hip screw versus IM nail in reverse
oblique trochanteric and subtrochanteric fractures. A
study of 2716 patients in the Norwegian Hip Fracture
Register. Injury. 2013; 44(6):735-42.
2. Kumar R, Singh RN, Singh BN. Comparative prospective
study of proximal femoral nail and dynamic hip screw
in treatment of intertrochanteric fracture femur. J Clin
Orthop Trauma. 2012; 3(1):28-36.
3. Knobe M, Gradl G, Ladenburger A, Tarkin IS, Pape HC.
Unstable intertrochanteric femur fractures: is there a
consensus on definition and treatment in Germany?
Clin Orthop Relat Res. 2013; 471(9):2831-40.
4. Mittal R, Banerjee S. Proximal femoral fractures:
principles of management and review of literature. J
Clin Orthop Trauma. 2012; 3(1):15-23.
5. Gilardino MS, Chen E, Bartlett SP. Choice of internal
rigid fixation materials in the treatment of facial
fractures. Craniomaxillofac Trauma Reconstr. 2009;
2(1):49-60.
6. Jaglal S, Lakhani Z, Schatzker J. Reliability, validity,
and responsiveness of the lower extremity measure
for patients with a hip fracture. J Bone Joint Surg Am.
2000; 82(7):955-62.
7. Schipper IB, Marti RK, van der Werken C. Unstable
trochanteric femoral fractures: extramedullary or
intramedullary fixation. Review of literature. Injury.
2004; 35(2):142-51.
8. Dhamangaonkar AC, Joshi D, Goregaonkar AB, Tawari
AA. Proximal femoral locking plate versus dynamic
hip screw for unstable intertrochanteric femoral
fractures. J Orthop Surg. 2013; 21(3):317-22.
9. Cai L, Wang T, Di L, Hu W, Wang J. Comparison of
intramedullary and extramedullary fixation of
stable intertrochanteric fractures in the elderly: a 
prospective randomised controlled trial exploring
hidden perioperative blood loss. BMC Musculoskelet
Disord. 2016; 17(1):475.
10. Desjardins AL, Roy A, Paiement G, Newman N, Pedlow
F, Desloges D, et al. Unstable intertrochanteric
fracture of the femur. A prospective randomised
study comparing anatomical reduction and medial
displacement osteotomy. J Bone Joint Surg Br. 1993;
75(3):445-7.
11. Reina N, Geiss L, Pailhe R, Maubisson L, Laffosse JM,
Chiron P. Traumax screw plate vs. Gamma nail. Blood
loss in pertrochanteric fractures treated by minimally
invasive osteosynthesis. Hip Int. 2014; 24(2):200-5.
12. Verettas DA, Ifantidis P, Chatzipapas CN, Drosos GI,
Xarchas KC, Chloropoulou P, et al. Systematic effects
of surgical treatment of hip fractures: gliding screwplating
vs intramedullary nailing. Injury. 2010;
41(3):279-84.
13. Reindl R, Harvey EJ, Berry GK, Rahme E; Canadian
Orthopaedic Trauma Society (COTS). Intramedullary
versus extramedullary fixation for unstable
intertrochanteric fractures: a prospective randomized
controlled trial. J Bone Joint Surg Am. 2015;
97(23):1905-12.
14. Gilat R, Lubovsky O, Atoun E, Debi R, Cohen O, Weil YA.
Proximal femoral shortening after cephalomedullary
nail insertion for intertrochanteric fractures. J Orthop
Trauma. 2017; 31(6):311-5.
15. Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R,
Hoffmeyer P. Pertrochanteric fractures: is there an
advantage to an intramedullary nail?: A randomized,
prospective study of 206 patients comparing the
dynamic hip screw and proximal femoral nail. J
Orthop Trauma. 2002; 16(6):386-93.
The Archives of Bone and Joint Surgery
Volume 8, Issue 2
March 2020
Pages 190-197

Files

History

  • Receive Date: 05 October 2018
  • Revise Date: 04 May 2019
  • Accept Date: 26 May 2019

Share

How to cite

Statistics