Sat., 10/18/08 Femur, Paper #48, 9:27 am OTA-2008
A Prospective Randomized Trial Comparing the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Unstable Pertrochanteric Hip Fractures
Timothy J. S. Chesser, MD (a-Stryker); Tristan M. Barton, MD (n); Robert Gleeson, MD (n);
Claire Topliss, MD (n); William J. Harries, MD (n);
Department of Trauma and Orthopaedics, Frenchay Hospital North Bristol NHS Trust,
Bristol, United Kingdom
Purpose: Controversy exists whether to treat unstable pertrochanteric hip fractures with either intramedullary or extramedullary devices. To help answer this question, a prospective, randomized controlled trial was performed to compare the outcome of unstable pertrochanteric hip fractures stabilized with either a sliding hip screw (SHS) or long gamma nail (LGN). The hypothesis was that there is no difference in outcome between the modes of treatment.
Methods: Over a 4-year period, 208 consecutive patients were recruited into the trial. All patients presenting with an unstable pertrochanteric hip fracture (AO/OTA 31 A2) were considered for recruitment. Eligible patients were randomized on admission to either a LGN or SHS. Follow-up was arranged for 3, 6, and 12 months. Primary outcome measures were implant failure and implant “cut-out”. Secondary measures included length of stay, mobility status, and EuroQoL outcome score. Statistical analysis was performed by a medical statistician.
Results: Outcome data were obtained for 85% of recruited patients, of whom 27% had died in the first postoperative year. The remaining patients were unavailable for review for a number of reasons, principally poor health. Five patients required revision surgery for implant cut-out, of which three were LGNs and two were SHSs (no significant difference). There were no incidences of implant failure, and tip apex distance (TAD) was not found to correlate with implant cut-out. There was a increased death rate in the postoperative period in the LGN group and this could be correlated with a low mental test score. No statistically significant differences were found between the outcome measures of the two groups, which included length of hospital stay, postoperative mobility, and EuroQoL outcome scores in the surviving patients.
Conclusions: There was no statistically significant difference in the reoperation rate or outcome scores following fixation of unstable pertrochanteric hip fractures with the LGN or SHS. There was a higher death rate in the early postoperative period in the LGN, which is correlated with a low mental test score Apart from this, there is no difference between these implants in the treatment of this frequently sustained fracture configuration in a prospective randomized trial using validated assessment tools. We suggest that the SHS is an appropriate implant in the treatment of unstable pertrochanteric fractures.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.