Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip--Blade vs screw.

With industrial societies getting older the incidence of femoral fractures is increasing. Complication rates up to 20% have led to a continuous improvement of intramedullar nailing systems and the third generation of implants is in clinical application. They seem superior to the second generation. But as clinical data is still fragmentary, we wanted to compare a second generation implant, the Proximal Femur Nail with three devices of the third generation: the Gleitnagel, Trochanter Fixation Nail and the Proximal Femur Nail Antirotation with a clinical study. We analysed whether fracture reduction and implant position could possibly be indicators for implant complications. Patients with a trochanteric fracture type A1-A3 (AO/ASIF classification) admitted at the department of traumatology Augsburg were enrolled. Postoperative X-rays were analysed in the matter of fracture reduction for the fracture gap, the Garden Alignment Index and for the matter of implant position in the femur head with the cleaveland zones and the Tip Apex Distance. 322 patients were enrolled. Most frequent was the A2 (n=240) and the A3 type of fracture (n=80) followed by A1 (n=29). Time to hospital discharge was 17 days (9/25), 12 patients died (3.2%). The complication rate (cutting out) in the third generation was lower (2.5-7%) than in the second generation (14%). The postoperative range of mobilisation compared to the old social status was in the groups with 34% similar after 3 months. The third generation nails are safe and reliable implants. Compared with second generation devices, fewer complications are observed. A correlation might be seen in the postoperative X-rays between the fracture reduction or implant position and implant related mechanical complications (cutting out).