Changing trends in the management of intertrochanteric hip fractures – A single centre experience

Abstract

With an annual incidence greater than 65,000 in the United Kingdom, hip fractures are a common but debilitating injury predominantly affecting those over 65. Treatment is based on the anatomical location of the fracture relative to the capsule of the hip joint - fractures occurring within it are treated by arthroplasty, while extracapsular fractures are an indication for fixation. Intertrochanteric fractures are further grouped as stable (AO/OTA 31A1/A2) or unstable (31A3) which in turn governs in the current UK guidelines whether this fixation is achieved with a dynamic hip screw or intramedullary device. Anecdotally, some units are tending towards intramedullary devices for 31A2 fractures as well, a practice which from the evidence does not appear to confer benefit and carries an excess cost. We reviewed our data submitted to the National Hip Fracture Database over the last five years and identified all intertrochanteric fractures, from which cohort we identified all patients with 31A2 fractures by review of radiographs. The cohort comprised 370 patients. We then recorded age, gender, ASA grade, abbreviated mental test score, residence from where admitted, length of stay, destination on discharge and whether any further operations were required. There was no significant difference in the demographics of the groups, year-on-year, except gender mix. There was a significant, twenty-fold rise in the use of intramedullary devices between 2011 and 2015. Length of stay, length of overall episode of care, revision rates, mortality and destination on discharge were unchanged. This use is not supported by NICE guidelines and this study offers no evidence to contradict this position. We advocate all centres examine their practice to avoid a costly intervention without clinical benefit.

A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in elderly patients with osteoporosis: a minimum follow-up of 3 years

“…With the aging population, the incidence of intertrochanteric fractures (IFs) is increasing [ 1 – 3 ]. Because elderly patients have comorbidities, the mortality rate from IFs in these patients is 12 to 41% within 6 months [ 4 , 5 ].…”

Incidence and predictive factors of problems after fixation of trochanteric hip fractures with sliding hip screw or intramedullary devices

“…This is in keeping with previous work by this team and other contemporaneously published rates for the UK. 10,13 This study builds on that work by predictive of re-admission or death within six months of hip fracture surgery 17 . Having established both the validity of the use of this score and the face validity of our results in the context of existing evidence, the novel aspect we wish to highlight is that health status is also predictive of other problems in our population, which may simply represent a limp or pain.…”

Comparison of two methods of locating proximal femoral nail anti-rotation in the treatment of femoral intertrochanteric fractures

“…In recent years, with the continuous development and improvement of internal fixation technology, PFNA has been widely used in the treatment of intertrochanteric fracture of the femur [7,8]. It has the advantages of a short operation time, less trauma, a quick recovery, and a high fracture healing rate.…”