Comparison of Intramedullary and Extramedullary Fixation of Basicervical Fractures of the Femur in the Elderly: A Prospective Randomized Study

Abstract

Basicervical fractures of the femur are a unique type of unstable hip fracture, usually treated with sliding hip screw (SHS) or cephalomedullary nail (CMN). The aim of this randomized, prospective study was to evaluate the outcomes and complications of the two different treatment methods, SHS and CMN, in the management of basicervical fractures of the femur in the elderly osteoporotic bones. Methods: Patients aged over 65 years, who presented to our clinic with basicervical fracture of the femur between January 2016 and January 2018, were included in the study. The permuted block randomization method was used to randomize the participants into groups. The patients were allocated to one of two groups treated via CMN (n=29) or SHS (n=27). Functional and radiological evaluations included mobility score, Harris Hip score, modified Barthel index, Singh index, tip-apex distance, and fracture settling. Results: Continuous improvement in the Barthel index was seen over the 12-month period in either group (p<0.05). The average mobility score was found to be decreased at the 6 th week follow-up visits in either group (p<0.05). The fracture settling measurements in SHS group was higher than in CMN group (p<0.01). Conclusion: The clinical and radiological outcomes of both CMN and SHS groups showed no superiority of one technique over the other in the treatment of basicervical fractures of the femur.

Dynamic hip screws versus cephalocondylic intramedullary nails for unstable extracapsular hip fractures in 2021: A systematic review and meta-analysis of randomised trials

“…Various randomisation techniques were employed across the included studies; in ten studies, randomisation was carried out using sealed envelopes that were computer-generated or generated by a medical statistician. 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 In three studies, randomisation was carried out by the operating surgeon 31 , 32 , 33 and in another three studies randomisation was carried out using number generators. 34 , 35 , 36 Six studies did not specify a randomisation technique.…”

Cephalomedullary Nailing versus Dynamic Hip Screw Fixation in Basicervical Femoral Neck Fracture: A Systematic Review and Meta-Analysis

“…Of the seven studies, 7 8 20 21 22 23 24 there were two randomized controlled trials (RCTs) 7 20 and the other five were retrospective cohort studies. 8 21 22 23 24…”

“…With regard to the eight main evaluation parameters, five studies 21-25 received a point deduction for their retrospective design. All seven studies 7 8 20 21 22 23 24 received a point deduction for the lack of double-blind evaluation of subject endpoints. One study 20 received a point deduction for loss to follow-up of up to 5% compared to the initial number of enrolled patients.…”

“…Four studies, 8 20 21 22 included data on the incidence of lag screw cut-out rate in the CMN and DHS groups. The pooled analysis showed no statistically significant difference in the incidence of cut-out between the two groups (OR=0.54; 95% CI: 0.10 to 2.82; p =0.47).…”

Treating peri-trochanteric hip fractures with intramedullary nail. When a second anti-rotational screw is necessary?

“…The IM nails have reduced lever arm and can substitute the lateral wall of the proximal part of the femur, presenting a theoretical mechanical advantage comparing to the DHS. On the other hand the application of a sliding hip screw system provides a continuous fracture compression while the patient weight bears, they have reduced cost in many countries and have comparable clinical outcomes with the IM nails (5).…”