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Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?

  • Symposium: Tscherne Festschrift
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

Level of Evidence

Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank Serkan Erkan MD for his meticulous efforts in the collection and organization of patients’ walking ability data.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Medical Faculty, Celal Bayar University, Manisa, 45250, Turkey

    Güvenir Okcu MD

  2. Department of Orthopaedics and Traumatology, Medical Faculty, Ege University, Izmir, Turkey

    Nadir Ozkayin MD & Kemal Aktuglu MD

  3. Demirci State Hospital, Demirci/Manisa, Turkey

    Cemil Okta MD

  4. Department of Anesthesia and Reanimation, Medical Faculty, Celal Bayar University, Manisa, Turkey

    Ismet Topcu MD

Authors
  1. Güvenir Okcu MD
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  2. Nadir Ozkayin MD
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  3. Cemil Okta MD
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  4. Ismet Topcu MD
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  5. Kemal Aktuglu MD
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Corresponding author

Correspondence to Güvenir Okcu MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Celal Bayar University (Manisa, Turkey) and Ege University (Izmir, Turkey).

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Okcu, G., Ozkayin, N., Okta, C. et al. Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?. Clin Orthop Relat Res 471, 2768–2775 (2013). https://doi.org/10.1007/s11999-013-2948-0

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  • DOI: https://doi.org/10.1007/s11999-013-2948-0

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