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Is the Best Plate a Nail? A Review of 3230 Unstable Intertrochanteric Fractures of the Proximal Femur

Tucker, Adam, MB BCh BAO, MRCS, MPhil*; Donnelly, Kevin, J., MB BCh BAO, MRCS*; Rowan, Clare, FRCS (Tr+Orth); McDonald, Sinead, RGN, PgDip; Foster, Andrew, P., FRCS (Tr+Orth)*

doi: 10.1097/BOT.0000000000001038
Original Article
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Objectives: To evaluate the functional outcomes, revision, and mortality rates of 3 implants used for unstable intertrochanteric hip fractures; the sliding hip screw (SHS), with or without a trochanteric stabilization plate (TSP); and a cephalomedullary nail (CMN).

Design: Multicentre National Prospective Cohort Study.

Setting: Northern Ireland.

Patient/Participants: Patients were identified from a prospective database. Fractures were classified according to OTA/AO A31A2.2, A2.3, and A3. All patients had a minimum of 12 months of follow-up.

Intervention: Patients received either an SHS, an SHS in combination with a TSP, or a CMN. Implant choice was at the discretion of the operating surgeon.

Outcome Measure: Primary outcome was 12-month mortality analyzed by the Kaplan–Meier survival analysis. Secondary outcomes included 12-month functional status using a validated score and all time revision of implants for any reason.

Results: In total, 3230 patients met the inclusion criteria (2474 SHS, 158 SHS + TSP, and 598 CMN). CMN use increased over time, with concomitant reduction in SHS use. There was no significant difference in functional outcomes at 12 months (analysis of variance, P = 0.177). Although men were significantly younger, they were at a higher risk of 12-month mortality. CMNs had statistically significantly lower 12-month mortality rates (P = 0.0148). The highest revision rate (4.04%) was seen in patients treated with SHS alone (P = 0.041).

Conclusions: The use of a CMN in unstable intertrochanteric hip fractures conveys the best results in functional outcomes, 12-month mortality, and has lower revision rates compared with an SHS ± TSP.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Trauma and Orthopaedics, Altnagelvin Area Hospital, Londonderry, Northern Ireland;

Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, Northern Ireland; and

Fracture Outcomes and Research Department (FORD), Royal Victoria Hospital, Belfast, Northern Ireland.

Reprints: Adam Tucker, MB BCh BAO, MRCS, MPhil, Trauma and Orthopaedics, Altnagelvin Area Hospital, Glenshane Rd, Londonderry BT47 6SB, Northern Ireland (e-mail: atuc@hotmail.com).

The authors report no conflict of interest.

Internal review board: Royal Victoria Hospital Trauma and Orthopaedic Research Group (TORG) approval.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Accepted September 18, 2017

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