Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly

Is a Sliding Hip Screw or IM Nail the Preferred Implant for Intertrochanteric Fracture Fixation?

“…Historically, a sliding hip screw (SHS) has been the preferred implant to stabilize these fractures [5,13,18,21,24,25,35]. However, intramedullary hip screw devices have gained popularity for stabilizing this fracture type [2,4,7,8,10,12,16,17,29,31,32].…”

CORR Insights™: Intramedullary Nails Result in More Reoperations Than Sliding Hip Screws in Two-part Intertrochanteric Fractures

“…Multiple studies have provided somewhat conflicting data [1][2][3][5][6][7][8][9][10][11][12].When all fracture patterns are considered, however, there does not appear to be any significant difference in blood loss, transfusion requirements, or operative times [1][2][3][5][6][7][8][9][10][11][12]. Postoperative complications, such as infection and thromboembolic phenomena, also are similar for the two groups [1][2][3][5][6][7][8][9][10][11][12].…”

“…Postoperative complications, such as infection and thromboembolic phenomena, also are similar for the two groups [1][2][3][5][6][7][8][9][10][11][12]. The presence of nonunions and fracture healing appear to be similar with the two types of implants as well [1][2][3][5][6][7][8][9][10][11][12].…”

“…Likewise, there does not appear to be any differences between the two methods regarding leg-length discrepancy, external rotation, or varus femoral neck deformity (although few studies look at these outcomes) [1-3, 7, 11, 12]. Operative fracture of the femur has been significantly worse when using the shorter cephalomedullary device, necessitating reoperation or changing the implant to a longer device [1][2][3][5][6][7][8][9][10][11][12]. This last finding was disputed by Bhandari et al [4], who performed a meta-analysis of more recent studies.…”

“…Short nails were used with 96% of the patients who had a cephalomedullary device, thus increasing the possibility of fracture around the implant. The main weakness of this study is that it does not compare the devices with the less stable fracture patterns, which is the primary indication for using a cephalomedullary device [1][2][3][4][5][6][7][8][9][10][11][12].…”