Author Affiliations
Abstract
Objective: We aimed to investigate the increased mortality associated with intramedullary nails (IMN) as compared to dynamic hip screws (DHS) in treating trochanteric hip fractures in the elderly population.[1]
Method: We conducted a retrospective study on 264 (n=264) patients operated in 2018-2019 at the department of orthopedics University Hospital Waterford. The study was conducted from August 01, 2023, till 01 November 2023. We used data from the Irish hip fracture database (IHFD) for the patient’s biodata, date of surgery, and laterality. The national integrated management system (NIMS) tool was used to interpret hip X-rays, while the inpatient management system (IPMS) software was used to check the date of mortality. Patient biodata, type of fracture using Arbeitsgemeinschaft für osteosynthesefragen (AO) classification[2] American society of anesthesiologists (ASA) grading, average time to surgery, reoperation, and average time to reoperation were also included as a part of the study.[3]
Results: This study confirms that there is a 13% increase in the risk of mortality with IMN compared with DHS in the treatment of trochanteric hip fractures. Out of the nails, mortality in long nails was 23% greater than in short IMN. The reoperation rate was 20% higher in DHS as compared to nails; however, the time to reoperation was earlier in IMN as compared to DHS (28%). It was clear that AO Type 2.1 was associated with a higher reoperation rate (44%). The most common fracture pattern was AO Type A1.2 (23%), while the least seen pattern was AO Type A3.2 (2%). The average waiting time to operate was 46% more in DHS than in Nails. The age group was between 60–99 years and peak incidence of the fracture was observed between 80-92 years. Most of the patients were female, n=174 (66%), and nearly half of the male population, n=90 (34%). Most of the patients had ASA grade II (29%) for nails, 38% for DHS, and ASA grade III (61%) for nails and (48%) for DHS.
Conclusion: It is clear from the study that nails have higher mortality than DHS, especially the long nails, which is concordant with Swedish and United Kingdom (UK) studies on the same.[6] However, larger-scale studies are needed to further strengthen this hypothesis. DHS has a higher reoperation rate, but[5] it takes a longer time for DHS to reoperate than for nails. Since there is little scientific evidence to support the use of nails over DHS, the current use of IMN rather than DHS may not be fully justified.[4]
Keywords
Intramedullary nails, Dynamic hip screw, Mortality, Irish hip fracture database, Intertrochanteric hip fracture.
Additional Information
The authors have informed the journal that the abstract of this study was previously presented at the University Hospital Waterford Annual Research Meeting, held in 19th January 2024 at the RCSI Auditorium. This information was provided post-publication and has been added for transparency. This update does not affect the scientific content, results, or conclusions of the article.
References
- Whitehouse MR, Berstock JR, Kelly MB, et al. Higher 30-day mortality associated with the use of intramedullary nails compared with sliding hip screws for the treatment of trochanteric hip fractures. Bone Joint J. 2019;101-B(1):83-91. doi:10.1302/0301-620X.101B1.BJJ-2018-0601.R2 PubMed | Crossref | Google Scholar
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- Dhaked GS, Jaroli AK, Malav KP, Rajpurohit HNS. Dynamic Hip Screw versus Proximal Femoral Nail in the management of intertrochanteric fractures: A retrospective analysis from Rajasthan. J Evid Based Med Healthc. 2021;8(26):2271-2277. doi:10.18410/jebmh/2021/424 Crossref
- Whitehouse MR, Berstock JR, Kelly MB, et al. Higher 30-day mortality associated with the use of intramedullary nails compared with sliding hip screws for the treatment of trochanteric hip fractures. Bone Joint J. 2019;101-B(1):83-91. doi:10.1302/0301-620X.101B1.BJJ-2018-0601.R2 PubMed | Crossref | Google Scholar
Acknowledgments
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Funding
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Author Information
Corresponding Author:
Rehman Sohail
Department of Orthopedics
University Hospital Waterford, Ireland
Email: sann090909@gmail.com
Co-Authors:
Khan Shehryar, O’Driscoll Conor, Cleary May
Department of Orthopedics
University Hospital Waterford, Ireland
Authors Contributions
All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.
Ethical Approval
Not applicable
Conflict of Interest Statement
Not reported
Guarantor
None
DOI
Cite this Article
Rehman S, Khan S, O’Driscoll C, Cleary M. Mortality Outcomes in Treating Intertrochanteric Hip Fractures Using Intramedullary Nails and Dynamic Hip Screw: A Retrospective Study. medtigo J Med. 2024;2(4):e30622447. doi:10.63096/medtigo30622447 Crossref
