Abstract
IntroductionA subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct.Materials and MethodsWe retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014–May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality.ResultsDuring the time period studied, 86 patients presented with a subtrochanteric fracture of the femur; with 74 patients (86%) receiving an IMN and 12 (14%) receiving a DHS. The comparative outcome measures reaching statistical significance were blood loss and radiation DAP. The DHS group showed a significantly lower mean blood loss of 776 ml compared to 1029 ml in the IMN group. Also, the DHS group showed a significantly lower mean DAP of 150.30 mGy cm2 compared to 288.86 mGy cm2 in the IMN group.ConclusionAlthough UK national guidelines recommend treating all subtrochanteric fractures with an IMN; the outcome measures assessed in our study did not show use of an IMN to be superior to a DHS. The DHS group showed a lower estimated blood loss and a reduced DAP. This, along with the reduced financial cost associated with a DHS, may support the use of DHS over IMN for certain subtrochanteric fractures of the femur. There may not be a single favourable implant for the treatment of subtrochanteric fractures as a whole; instead different subtypes of fracture may be amenable to a number of fixation devices. Choice of implant should be determined locally and based on existing and future clinical and health economic research.
Highlights
A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter
Gender distribution was 81% female and 19% male in the intramedullary nail (IMN) group compared to 75% female and 25% male in the dynamic hip screw (DHS) group
The mean dose area product (DAP) was significantly higher (P = 0.000184) in the IMN group with a mean value of 288.9 mGy cm2 compared to 150.3 mGy cm2 in the DHS group
Summary
A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. Materials and Methods We retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014–May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality. The DHS group showed a significantly lower mean blood loss of 776 ml compared to 1029 ml in the IMN group. The majority of hip fractures are due to ‘fragility’ fractures in older people with osteoporosis or osteopenia presenting after a fall [2].
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