Dynamic hip screw fixation of subtrochanteric femoral fractures

Zaki Arshad; Azeem Thahir; Jaikirty Rawal; Peter D Hull; Andrew D Carrothers; Matija Krkovic; Daud T S Chou

doi:10.1007/s00590-021-02895-4

Dynamic hip screw fixation of subtrochanteric femoral fractures

Eur J Orthop Surg Traumatol. 2021 Oct;31(7):1435-1441. doi: 10.1007/s00590-021-02895-4. Epub 2021 Feb 16.

Authors

Zaki Arshad¹, Azeem Thahir², Jaikirty Rawal², Peter D Hull², Andrew D Carrothers², Matija Krkovic², Daud T S Chou²

Affiliations

¹ University of Cambridge School of Clinical Medicine, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK. mza26@cam.ac.uk.
² Cambridge Orthopaedic Trauma Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

Abstract

Introduction: A subtrochanteric proximal femur fracture occurs in the 5 cm of bone immediately distal to the lesser trochanter. UK national guidelines advise that adults with subtrochanteric fractures should be treated with an intramedullary nail (IMN). This study aims to compare peri-operative outcome measures of patients with subtrochanteric fractures treated with either an IMN or a dynamic hip screw (DHS) construct.

Materials and methods: We retrospectively reviewed subtrochanteric fractures presenting at our institution over 4.5 years (October 2014-May 2019), classifying them into two treatment groups; IMN and DHS. These groups were compared on outcome measures including surgical time, blood loss, radiation dose area product (DAP), length of stay, re-operation rate and mortality.

Results: During the time period studied, 86 patients presented with a subtrochanteric fracture of the femur; with 74 patients (86%) receiving an IMN and 12 (14%) receiving a DHS. The comparative outcome measures reaching statistical significance were blood loss and radiation DAP. The DHS group showed a significantly lower mean blood loss of 776 ml compared to 1029 ml in the IMN group. Also, the DHS group showed a significantly lower mean DAP of 150.30 mGy cm² compared to 288.86 mGy cm² in the IMN group.

Conclusion: Although UK national guidelines recommend treating all subtrochanteric fractures with an IMN; the outcome measures assessed in our study did not show use of an IMN to be superior to a DHS. The DHS group showed a lower estimated blood loss and a reduced DAP. This, along with the reduced financial cost associated with a DHS, may support the use of DHS over IMN for certain subtrochanteric fractures of the femur. There may not be a single favourable implant for the treatment of subtrochanteric fractures as a whole; instead different subtypes of fracture may be amenable to a number of fixation devices. Choice of implant should be determined locally and based on existing and future clinical and health economic research.

Keywords: Hip fractures; Hip screws; Internal fixation; Intramedullary nails; Subtrochanteric fractures.

MeSH terms

Adult
Bone Nails
Bone Screws
Femoral Fractures*
Fracture Fixation, Internal / adverse effects
Fracture Fixation, Intramedullary* / adverse effects
Hip Fractures* / diagnostic imaging
Hip Fractures* / surgery
Humans
Retrospective Studies
Treatment Outcome