The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Complication Rates in Intertrochanteric Fractures: A Database Analysis Comparing Sliding Hip Screw and Cephalomedullary Nail

Document Type : RESEARCH PAPER

Authors
Kamil M. Amer
Dominick V. Congiusta
Kunj Jain
Robert L. DalCortivo
Joseph Benevenia
Michael M. Vosbikian
Irfan H. Ahmed
Rutgers New Jersey Medical School Department of Orthopaedics, Newark, United States
10.22038/abjs.2024.64188.3081
Abstract
Objectives: In the treatment of closed intertrochanteric fractures, the two most common treatment 
options are intramedullary medullary nail (IMN) and dynamic hip screw (DHS), yet the best treatment 
method remains controversial. The purpose of this study is to determine the difference in mortality and 
morbidity between IMN and DHS. Secondarily, this study determines which pre -operative risk factors 
affect rates of morbidity and mortality.
Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2006-2016 
database was used to search for patients with a closed intertrochanteric hip fracture. Bivariate analysis was 
performed using Pearson’s Chi Square test to determine pre-operative risk factors associated with complications in 
fixation with IMN and DHS. Significant variables in this analysis, as well as demographic data, were analyzed via 
binary logistic regression. The results were recorded as odds ratio (OR) and significant differences were based on 
a P<0.05.
Results: After adjusting for demographics and clinical covariates, patients who underwent fixation with IMN had 
higher 30-day mortality, reintubation, UTI, bleeding, prolonged length of stay, and non-home discharged destination 
rates compared to DHS. Mortality risk was increased by ascites, disseminated cancer, impaired functional status, 
history of congestive heart failure, and hypoalbuminemia. Bleeding risk was increased by previous percutaneous 
coronary (PCI) and transfusions and was decreased by impaired functional status. Myocardial infarction risk was 
increased by female gender.
Conclusion: Our study found that IMN fixation increased risk of mortality, UTI, reintubation, bleeding, prolonged 
length of stay, and a non-home discharge destination compared to DHS. This study also identified patient risk factors 
associated with several postoperative complications. These data may better inform orthopaedic surgeons treating 
closed intertrochanteric fractures.
 Level of evidence: III
Keywords
Database
Hip fractures
NSQIP
Open reduction internal fixation
Outcomes
Subjects

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The Archives of Bone and Joint Surgery
Volume 12, Issue 7
July 2024
Pages 506-514

  • Receive Date 12 March 2022
  • Revise Date 03 May 2024
  • Accept Date 05 May 2024