Original Article

Clinical Orthopaedics and Related Research

, Volume 466, Issue 11, pp 2827-2832

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

  • Brian ArosAffiliated withMultidisciplinary Clinical Research Center in Musculoskeletal DiseasesDepartment of Orthopaedics, Dartmouth Medical School
  • , Anna N. A. TostesonAffiliated withMultidisciplinary Clinical Research Center in Musculoskeletal DiseasesThe Dartmouth Institute for Health Policy and Clinical PracticeDepartment of Medicine, Dartmouth Medical SchoolDepartment of Community and Family Medicine, Dartmouth Medical School
  • , Daniel J. GottliebAffiliated withThe Dartmouth Institute for Health Policy and Clinical Practice
  • , Kenneth J. KovalAffiliated withMultidisciplinary Clinical Research Center in Musculoskeletal DiseasesDepartment of Orthopaedics, Dartmouth Medical School Email author 

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Abstract

This study was performed to determine whether patients who sustain an intertrochanteric fracture have better outcomes when stabilized using a sliding hip screw or an intramedullary nail. A 20% sample of Part A and B entitled Medicare beneficiaries 65 years or older was used to generate a cohort of patients who sustained intertrochanteric femur fractures between 1999 and 2001. Two fracture implant groups, intramedullary nail and sliding hip screw, were identified using Current Procedural Terminology and International Classification of Diseases, 9th Revision codes. The cohort consisted of 43,659 patients. Patients treated with an intramedullary nail had higher rates of revision surgery during the first year than those treated with a sliding hip screw (7.2% intramedullary nail versus 5.5% sliding hip screw). Mortality rates at 30 days (14.2% intramedullary nail versus 15.8% sliding hip screw) and 1 year (30.7% intramedullary nail versus 32.5% sliding hip screw) were similar. Adjusted secondary outcome measures showed significant increases in the intramedullary nail group relative to the sliding hip screw group for index hospital length of stay, days of rehabilitation services in the first 6 months after discharge, and total expenditures for doctor and hospital services.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.