Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults

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.…”

“…Short nail proponents chose ease of technique (59%) and equivalency of outcomes to a long nail (24%) as their reasons for using short cephalomedullary nails. Studies have suggested a higher risk of periimplant fracture with cephalomedullary nails compared with sliding hip screws [19,25,28], but Norris et al [25] found that newer designs of cephalomedullary nails have a significantly decreased rate of periimplant fracture compared with their predecessors. Boone et al [6] performed a retrospective study of intertrochanteric fractures treated with either a long or short cephalomedullary nail with minimum 1-year followup, finding no difference in the rate of 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].…”

“…Intertrochanteric fractures comprise approximately 50% of these. Historically, a sliding compression screw has been the preferred implant [19,28,30,34]; however, cephalomedullary nailing has become an increasingly popular fixation technique for these fractures since its introduction in the 1980s [2,7,12]. Cephalomedullary nailing has theoretical advantages of being less invasive and biomechanically superior, providing a buttress to limit fracture collapse [21].…”