Comparison of intramedullary nail and extramedullary fixation for unstable subtrochanteric fractures

Abstract

Objective To compare the effectiveness of intramedullary nailing (IN) and extramedullary fixation (EF) in the treatment of unstable subtrochanteric fractures.Methods From January 2005 to August 2011,our department treated 65 patients with unstable subtrochanteric fracture (Russell-Taylor type B).They were 40 men and 25 women,aged from 32 to 87 years(average,53.4 years).Of them,34 were fixated with IN and 31 with EF [locking compression plating (LCP) used in 21 cases and dynamic hip screwing (DHS) in 10 cases].The operation time,intraoperative blood loss,reduction quality,hospital stay,fracture healing time and Harris scores of the hip at 12-month follow-up were recorded and compared between the 2 groups.Results The 65 patients obtained an average follow-up time of 15.6 months(range,12 to 18 months).Compared with the EF group,the IN group had significantly shorter operation time (67.9 ± 19.0 minutes versus 79.8 ± 22.4 minutes),significantly less intraoperative blood loss (112.6 ± 63.4 mL versus 178.5 ± 97.5 mL),significantly shorter healing time (21.0 ± 6.5 weeks versus 28.0 ± 8.7 weeks),and significantly higher Harris scores (83.4 ± 8.1 points versus 79.2 ± 7.4 points) (P ＜ 0.05),but there were no significant differences between the 2 groups in reduction quality or hospital stay (P ＞ 0.05).Nonunion occurred in 2 patients who had had LCP but was cured after the LCP was changed into IN.Both the IN group and the EF group had one case of malunion.Conclusion Intramedullary nailing may be a better treatment for unstable subtrochanteric fractures than extramedullary fixation. Key words: Hip fractures; Fracture fixation, internal; Bone nails; Bone plates