14,415 Patient Fracture Study: Screws or Nails? | Orthopedics This Week
Trauma

14,415 Patient Fracture Study: Screws or Nails?

X-ray of a comminuted trochanteric hip fracture / Rohan R. Memon, Drashtant Patel and Nishant Juva – (2019). “Cannulated Cancellous Screw and Ender’s Nail Fixation in Stable Intertrochanteric Femur Fracture in Elderly Patient with Co-Morbid Condition”. Journal of Advances in Medicine and Medical Research 28(6): 1–10. DOI:10.9734/JAMMR/2018/46629. ISSN 24568899. Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0)

Using the American College of Surgeons National Quality Improvement Program (NSQIP) database, George Washington University researchers studied 14,415 trauma patients to determine whether there were any outcome differences between sliding hip screws and cephalomedullary nails in intertrochanteric hip fractures.

The study, “Comparison of Short-term Complication Rates Between Cephalomedullary Hip Screw Devices and Sliding Hip Screws: An Analysis of the National Surgical Quality Improvement Program Database,” was published in the Journal of the American Academy of Orthopaedic Surgeons.

Rajeev Pandarinath, M.D., an orthopedic surgeon and studyco-author explained the rationale for the study to OTW: “Treatment of intertrochanteric fractures of the hip is one of the most commonly performed procedures in orthopedic surgery. Historically, there is a long track record for the sliding hip screw, and more recently many surgeons have switched to the cephalomedullary nail for treatment of the fracture, and it is now the most common treatment for intertrochanteric hip fractures.”

“We wanted to study whether there were any differences in short term complication rates between the two devices using the NSQIP database, which is a national database that comprises a variety of hospital types.”

“Even after controlling for preoperative factors, there were several complications that were more prevalent in the cephalomedullary nailing group, including mortality, bleeding, pulmonary complications and clotting events. There was a higher rate of urinary tract infection and hospital length of stay in the sliding hip screw group.”

“Although further studies are needed, there may be a higher rate of complications related to the cephalomedullary nail. We would suggest that surgeons weigh the pros and cons of both implants for the individual patient when planning their hip fracture surgery. For example, a patient with poor baseline pulmonary function or bleeding risk may be a better candidate for the sliding hip screw if both implants are appropriate for the fracture type.”

“It is difficult to know whether the differences found in our study are directly related to the implants used. Further studies are needed that are prospective and randomized with matched comorbidities in each group.”

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11 thoughts on “14,415 Patient Fracture Study: Screws or Nails?

  1. Like other studies this I’ve did not separate the non displaced from displaced interthroch fractures. Having said that the sliding hip screw is an excellent implant for the non displaced and minimally displaced fractures and has s significantly lower cost

  2. Interesting discussion of an age old debate. Too bad your radiographic depiction was certainly not an intertrochanteric but rather a displaced and comminuted subcapital fracture for which arthroplasty would be the treatment of choice. Perhaps a bit more professionalism in your editing department might be in order…

  3. Lots of these research papers are being written by undergraduates in conjunction with medical students and a junior resident. After all, you just plug the data into a statistical program. It is amazing how many practicing Orthopedic Surgeons said, “You need a THR because ORIF with both devices will fail”. Practicing guys know something after all.

  4. An important retrospective study that adds to our knowledge and should inspire a prospective clinical trial. The commenters point out that there will be some fractures with intertrochanteric involvement that might also be treated by some surgeons with arthroplasty. We would need to know more about the pictured patient and see more than one film to come to that conclusion. I believe that many patients with the pictured fracture would be best served by internal fixation.

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