Thurs., 10/4/12 Hip Fractures, PAPER #27, 3:20 pm OTA-2012
More Reoperations After Intramedullary Nailing Compared With Sliding Hip Screws in the Treatment of AO/OTA Type A1 Trochanteric Fractures:Results After 7643 Operations Reported to the Norwegian Hip Fracture Register
Kjell Matre, MD; Leif Ivar Havelin, MD, PhD; Jan Erik Gjertsen, Tarjei Vinje;
Birgitte Espehaug; Jonas M. Fevang, MD;
Orthopaedic Department, Haukeland University Hospital, Bergen, Norway
Purpose: Sliding hip screws (SHS) and intramedullary (IM) nails are frequently used and well-documented implants for trochanteric fractures. There is no consensus as to which method is the best, and different treatment algorithms based on fracture type has been proposed. The aim of the present study was to compare the results for IM nailing and SHS in the treatment of AO/OTA type A1 trochanteric fractures using data from the Norwegian Hip Fracture Register (NHFR).
Methods: Data on 7643 primary operations for AO/OTA type A1 trochanteric fractures treated with either a SHS (n = 6355) or an IM nail (n = 1288) in the years 2005–2010 were collected from the NHFR. Patients’ baseline characteristics and details from primary operations and reoperations were recorded by the surgeons. Questionnaires about pain and quality of life (EQ-5D) were answered by the patients 4, 12, and 36 months postoperatively. Reoperation percentages at 1 and 3 years were estimated using the Kaplan-Meier method and the Cox regression model was used to assess any influence of age, gender, comorbidity (American Society of Anesthesiologists [ASA] class), cognitive impairment, and implant on reoperation rates.
Results: Overall, 249 reoperations were identified, 189 (3.0%) within the SHS group and 60 (4.7%) within the IM nail group. In the survival analyses 1-year reoperation percentages were 2.4% and 4.2% for SHS and IM nails, respectively. The difference between the implants persisted over time, and at 3 years reoperation percentages were 4.5% for SHS and 7.1% for IM nails. In the Cox regression analyses, higher age and cognitive impairment reduced the risk of reoperation, whereas gender and ASA-class had no significant influence on the reoperation rate. The adjusted relative risk of reoperation for patients operated with an IM nail compared to a SHS was 1.61 (95% confidence interval [CI], 1.19-2.17; P = 0.002). For pain and quality of life (EQ-5Dindex score), no statistically significant differences between the treatment groups were found during 3 years of follow-up. However, the rating of the two dimensions “mobility” and “usual activities” in the EQ-5D questionnaire were statistically significant in favor of IM nailing 1 year postoperatively.
Conclusion: We found more reoperations after IM compared to SHS in the treatment of the simple two-part trochanteric fractures 1 and 3 years postoperatively. A temporary and slightly better rating of the mobility for the IM nail group 1 year postoperatively cannot compensate for this. No difference of clinical relevance was found for pain or overall quality of life at any time during follow-up. Accordingly, despite modern trends suggesting otherwise, the SHS seems to be the best treatment for the simple two-part trochanteric fractures.
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• 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.