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

  • Original Article
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Clinical Orthopaedics and Related Research

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.

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Author information

Authors and Affiliations

  1. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Lebanon, NH, USA

    Brian Aros MD, MS, Anna N. A. Tosteson ScD & Kenneth J. Koval MD

  2. Department of Orthopaedics, Dartmouth Medical School, 1 Medical Center Drive, Lebanon, NH, USA

    Brian Aros MD, MS & Kenneth J. Koval MD

  3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

    Anna N. A. Tosteson ScD & Daniel J. Gottlieb MS

  4. Department of Medicine, Dartmouth Medical School, Lebanon, NH, USA

    Anna N. A. Tosteson ScD

  5. Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA

    Anna N. A. Tosteson ScD

Authors
  1. Brian Aros MD, MS
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  2. Anna N. A. Tosteson ScD
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  3. Daniel J. Gottlieb MS
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  4. Kenneth J. Koval MD
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Corresponding author

Correspondence to Kenneth J. Koval MD.

Additional information

One or more of the authors (DG, AT) have received funding from National Institutes of Health grants AG12262 and AR048094, US Public Health Service.

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Aros, B., Tosteson, A.N.A., Gottlieb, D.J. et al. Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?. Clin Orthop Relat Res 466, 2827–2832 (2008). https://doi.org/10.1007/s11999-008-0285-5

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  • DOI: https://doi.org/10.1007/s11999-008-0285-5

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