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Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur

International Orthopaedics volume 38, pages 155–161 (2014)Cite this article

Abstract

Purpose

The purpose of this prospective randomised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures

Methods

Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) intertrochanteric fracture were randomly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device.

Results

All patients were followed up at one, three, six and 12 months postoperatively, except for nine who died. There was no statistical difference in Parker mobility score between groups. The Gamma nail group had significantly higher Barthel Index and EuroQol-5D (EQ-5D) scores than the AMBI group at 12 months. At the same time, the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group. There were no differences in mortality, radiation time and hospital stay. Duration of the operation, incision length and hip pain occurrence were significantly less in the Gamma nail group.

Conclusions

Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw. Nevertheless, an intramedullary nail seems superior in reconstituting patients to their pre-operative state.

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Acknowledgments

The authors thank the Medical School of Kapodistrian University of Athens for their guidance, where this paper forms part of the corresponding author’s PhD thesis.

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Authors and Affiliations

  1. ‘E Orthopaedic Department, KAT General Hospital, Athens, Attica, Greece

    Ioannis Aktselis, Constantine Kokoroghiannis, Evaggelos Fragkomichalos, Georgios Koundis, Anastasios Deligeorgis & Emmanouil Daskalakis

  2. 3rd Orthopaedic Department, University of Athens, KAT General Hospital, Athens, Attica, Greece

    John Vlamis

  3. Laboratory for Research of Musculoskeletal System ‘Theodoros Garofalidis’, University of Athens, KAT General Hospital, Athens, Attica, Greece

    Nikolaos Papaioannou

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  1. Ioannis Aktselis
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  2. Constantine Kokoroghiannis
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Correspondence to Ioannis Aktselis.

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Aktselis, I., Kokoroghiannis, C., Fragkomichalos, E. et al. Prospective randomised controlled trial of an intramedullary nail versus a sliding hip screw for intertrochanteric fractures of the femur. International Orthopaedics (SICOT) 38, 155–161 (2014). https://doi.org/10.1007/s00264-013-2196-7

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