BACKGROUND: Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing. QUESTIONS/PURPOSES: We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate. METHODS: We conducted a pilot prospective randomized controlled trial comparing standard versus long (≥ 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months). RESULTS: We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm). CONCLUSIONS: Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.
RCT Entities:
BACKGROUND: Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing. QUESTIONS/PURPOSES: We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate. METHODS: We conducted a pilot prospective randomized controlled trial comparing standard versus long (≥ 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months). RESULTS: We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm). CONCLUSIONS: Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.
Authors: Christophe Sadowski; Anne Lübbeke; Marc Saudan; Nicolas Riand; Richard Stern; Pierre Hoffmeyer Journal: J Bone Joint Surg Am Date: 2002-03 Impact factor: 5.284
Authors: Tristan M Barton; Robert Gleeson; Claire Topliss; Rosemary Greenwood; William J Harries; Timothy J S Chesser Journal: J Bone Joint Surg Am Date: 2010-04 Impact factor: 5.284
Authors: Marc Saudan; Anne Lübbeke; Christophe Sadowski; Nicolas Riand; Richard Stern; Pierre Hoffmeyer Journal: J Orthop Trauma Date: 2002-07 Impact factor: 2.512
Authors: I B Schipper; E W Steyerberg; R M Castelein; F H W M van der Heijden; P T den Hoed; A J H Kerver; A B van Vugt Journal: J Bone Joint Surg Br Date: 2004-01
Authors: L Henry Goodnough; Brett P Salazar; Jamie Furness; James E Feng; Malcolm R DeBaun; Sean T Campbell; Justin F Lucas; William W Cross; Philipp Leucht; Kevin D Grant; Michael J Gardner; Julius A Bishop Journal: Eur J Orthop Surg Traumatol Date: 2020-09-09
Authors: Xavier Lizano-Díez; Marius Johann Baptist Keel; Klaus Arno Siebenrock; Marc Tey; Johannes Dominik Bastian Journal: Eur J Trauma Emerg Surg Date: 2020-01-03 Impact factor: 3.693