A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of AO/OTA 31-A2 Fractures of the Proximal Part of the Femur

Abstract

When compared with the long gamma nail, the sliding hip screw should remain the gold standard for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur because it is associated with similar outcomes with less expense.

Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons

“…There continues to be controversy regarding the optimum treatment of intertrochanteric fractures [3,5,25,27,28,30,32]. Several large prospective randomized trials have directly compared sliding hip screws and contemporary cephalomedullary nail constructs and have shown similar outcomes between the two techniques [3,27,28,30,34].…”

“…There continues to be controversy regarding the optimum treatment of intertrochanteric fractures [3,5,25,27,28,30,32]. Several large prospective randomized trials have directly compared sliding hip screws and contemporary cephalomedullary nail constructs and have shown similar outcomes between the two techniques [3,27,28,30,34]. The most recent Cochrane review on the topic [28] concluded that the sliding hip screw is the superior construct for treatment of intertrochanteric fractures because of the decreased rate of surgical complications compared with cephalomedullary nails, but additional studies are necessary to determine whether newer designs of cephalomedullary nails avoid the complications of older models, such as those used for periimplant fracture.…”

“…Particular fracture patterns, such as those with reverse obliquity, subtrochanteric extension, fracture extension into the lateral wall, or greater trochanteric avulsion [23,26,33], have lower rates of failure and reoperation when treated with a cephalomedullary nail than a sliding hip screw. However, to our knowledge, no study has found one construct to be clearly superior in the treatment of commonly encountered conventional obliquity fracture patterns, and controversy over the optimal treatment strategy persists [3,5,25,27,28,30,32].…”

“…There is difficulty reaching a consensus based on available evidence given the heterogeneity of fracture patterns and implant designs reported in the literature [3,18,27,30,34]. Despite this uncertainty, data collected between 1999 and 2006 indicated that cephalomedullary nailing was overtaking use of sliding hip screws as the preferred technique for fixation of these fractures, particularly among younger surgeons [2].…”

“…(2) Do surgical practice patterns differ based on surgeon characteristics, practice setting, and other factors? (3) What is the rationale behind these surgical practice patterns? (4) What postoperative approaches do surgeons use for intertrochanteric fractures?…”