Effects of intramedullary nailing versus dynamic hip screwing on hip abduction in the treatment of intertrochanteric fractures

Abstract

Objective To compare intramedullary nail (IN) and dynamic hip screw (DHS) regarding their effects on hip abduction following fixation of intertrochanteric fractures. Methods From January 2008 to December 2015, 310 patients with intertrochanteric fracture were treated at our department. They were divided into 2 groups depending on the manner of treatment. 198 patients (71 males and 127 females) were subjected to intramedullary nailing, with an average age of 74.7±5.6 years; there were 50 cases of 31-A1, 134 ones of 31-A2 and 14 ones of 31-A3 according to the AO classification. 112 patients (35 males and 77 females) were subjected to dynamic hip screwing, with an average age of 74.1±6.7 years; there were 24 cases of 31-A1, 78 ones of 31-A2 and 10 ones of 31-A3. The 2 groups were compared in terms of time for weight-bearing ambulation and stand on one leg, gait, pelvic tilt, range of hip active abduction, muscle strength of the abductor and hip function at the final follow-up. Results Of this series, 284 patients were followed up for 1.5 to 8.5 years (average, 3.6 years) and 26 patients died. The IN group achieved significantly better outcomes in terms of time for weight-bearing ambulation (37.6±4.9 d), time for stand on one leg (60.1±9.5 d), cases of normal gait and normal pelvic tilt (171 and 179), muscle strength of the abductor (62.3±4.4 N·m), and range of hip active abduction than the DHS group (53.0±8.4 d; 71.0±12.0 d; 67 and 85; 56.6±3.3 N·m, respectively) (P 0.05). Conclusion Compared with dynamic hip screwing, intramedullary nailing has a limited effect on hip abduction so that the patients may benefit from quicker functional recovery and faster improvement in quality of life. Key words: Hip fractures; Fracture fixation, internal; Bone nails; Abductor