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Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 7, pp 961–968 | Cite as

Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis

  • Young-Kyun Lee
  • Chin Youb Chung
  • Moon Seok ParkEmail author
  • Kyoung Min Lee
  • Kyung-Hoi Koo
Trauma Surgery

Abstract

Background

The best options of internal fixation for unstable intertrochanteric femoral fractures in elderly osteoporotic patients remain controversial. We determined whether intramedullary nail or extramedullary plate provides better treatment for unstable intertrochanteric fractures using a decision analysis tool that considers quality of life.

Methods

A decision analysis model was constructed containing final outcome score and the probability of mortality within 1 year, infection, and mechanical complications. Final outcome was defined as health-related quality of life and was used as a utility in the decision tree. Probabilities were obtained by literature review, and health-related quality of life was evaluated by asking 30 orthopedic experts to complete a questionnaire. A roll back tool was used to determine the best surgical option, and sensitivity analysis was performed to compensate for decision model uncertainty.

Results

The decision model favored intramedullary nailing in terms of quality of life. In one-way sensitivity analysis, intramedullary nailing was more beneficial than the extramedullary plating, when probability of mechanical complication after intramedullary nailing was below 0.258.

Conclusions

In terms of quality of life, the decision analysis model showed that intramedullary nailing was more beneficial for patients with an unstable intertrochanteric fracture.

Keywords

Unstable intertrochanteric fracture Internal fixation Intramedullary nail Extramedullary plate Decision analysis 

Notes

Acknowledgments

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Conflict of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Young-Kyun Lee
    • 1
  • Chin Youb Chung
    • 1
  • Moon Seok Park
    • 1
    Email author
  • Kyoung Min Lee
    • 1
  • Kyung-Hoi Koo
    • 1
  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnam-siSouth Korea

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