Mobility after intertrochanteric hip fracture fixation with either a sliding hip screw or a cephalomedullary nail: Sub group analysis of a randomised trial of 1000 patients

Abstract

AimsThe aim of this study was to determine if different patient groups have superior mobility regain following intertrochanteric hip fracture fixation with a cephomedullary nail compared to a sliding hip screw (SHS). Patients and methodsThe present study is a subgroup analysis of patients which were enrolled into a randomized controlled trial which randomized 1000 patients with an intertrochanteric hip fracture to fixation with either a short cephomedullary nail (Targon® PF or PFT) or a SHS. In the present study the two treatment groups were dicotomised on the basis of six variables determined at the time of admission; age (<80; ≥80 years), sex, residence (admitted from own home; institutional care), mobility (mobility score ≥7 [good]; <7 [poor]), mental status (AMTS < 7 [cognitively impaired]; ≥7) and health status (ASA < 3; ≥3). The primary outcome measure was the difference between mobility score pre-fracture and mobility score during the year after hip fracture fixation. ResultsPatients less than 80 years of age, those admitted from their own home, cognitively intact patients and patients who mobilised without assistance pre-fracture, recovered superior mobility when fracture fixation was performed with a nail compared to a SHS. Those patients admitted from institutional care, those with significant cognitive or mobility impairment at the time of the injury did not have any significantly improved benefit in mobility regain with a nail compared to a SHS. ConclusionFixation of an intertrochanteric hip fracture with a cephomedullary nail results in superior recovery of mobility for younger patients who prior to the injury were more mobile, cognitively intact and living at home.