Reply to Letter to the Editor: Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures
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- Matre, K., Havelin, L.I., Gjertsen, JE. et al. Clin Orthop Relat Res (2013) 471: 1735. doi:10.1007/s11999-013-2892-z
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We thank Drs. Akcay, Satoglu, and Kurtulmuş for their response to our article . We agree that analyses of the patients’ radiographic images would add important information to the question whether intramedullary nails or sliding hip screws should be the preferred implants for trochanteric fractures. Valuable information also would be added if we could access patient files to correlate clinical findings to radiographic and overall outcome. We appreciate their idea of separately addressing the reasons for reoperations, and will consider future studies as they described.
Preferably, radiographs and files from patients with and without complications or reoperations should be analyzed in such studies to address the reasons for failure in detail. This would enable us to better characterize failures and relate them to the initial fracture reduction and implant position (such as the tip-apex distance). However, in a large hip fracture registry including thousands of patients, collecting, classifying, and analyzing radiographs and patient files would be a major challenge and add a substantial workload to those running the registry and to all colleagues and hospitals reporting data to the registry. In our opinion, a well-performed, randomized, controlled trial, including the radiographic analyses suggested by Drs. Akcay, Satoglu, and Kurtulmus probably would be the best way to distinguish between implant and surgeon-related causes for reoperations. We recently published such a study including almost 700 patients .
Finally, despite that treatment with the sliding hip screw is considered the gold standard for this fracture type, the number of operations with intramedullary nails for simple two-part trochanteric fractures is increasing [1, 4]. Therefore, registry data as presented in our article need to be published, and the evidence-based bottom line should not be forgotten.