1081 The Challenge of Fixing Multi-Fragmentary Neck of Femur Fractures: A Retrospective Case Control Study for Unstable A2 Type Neck of Femur Fractures Fixed with Dynamic Hip Screws, and Short Intramedullary Nails

Abstract

Abstract Aim Not all Neck of Femur (NOF) fractures are equivalent. AO-A2 subtype are multi-fragmentary and include a lesser trochanter fracture; they can be inherently unstable. Some believe Intramedullary Nails (IMN) offer greater stability however there is concern regarding increased operative time and blood loss. This project compared operative time and perioperative blood loss between Dynamic Hip Screw (DHS) and IMN used to treat matched groups of A2 NOF fractures. Method A patient list was compiled from the national hip fracture database from 01/01/2020 to 31/05/2022. Fractures were classified according to AO standards; radiographs pre- and post-surgery, blood results, and operative records were reviewed. Results A total of 41 IMNs were performed for A2 NOF fractures, a comparison group of 41 patients treated with DHS was created. Patients were matched for ASA grade. The IMN group had an average ASA of 3.0 (DHS 3.1), perioperative haemoglobin drops of 30.8 (DHS 29.8), operation time of 64 minutes (DHS 57), and Tip Apex Distance (TAD) of 19.6mm (DHS 24.8). The difference in perioperative haemoglobin drop and operating time were not statistically significant. The TAD was significantly lower in the IMN group. Conclusions There was no difference in surgical time or perioperative blood loss. An improved TAD in the IMN group, despite less surgical experience with this implant, may correlate with lower long-term rates of failure. Our project suggests IMN is a safe implant, at least in the short term for A2 fractures, but further research of long-term benefits including mobility and pain is required.