Comparison of Extramedullary and Intramedullary Implants for Stable Intertrochanteric Fractures: Have We Swung the Pendulum Too Far the Other Way?

Abstract

Introduction: Although intramedullary implants are commonly used to treat stable intertrochanteric (IT) fractures, there is a lack of evidence to demonstrate their superiority over extramedullary implants in treating these fractures. The purpose of this study was to compare short-term outcomes (,30 days) between intramedullary and extramedullary implants in patients with closed nondisplaced stable IT fractures. Methods: Patients with closed nondisplaced stable IT fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2016 and 2019. Patients who either underwent extramedullary implant or intramedullary implant fixation were selected for this analysis. Postoperative outcomes included transfusion, surgical complications (stroke, myocardial infarction, venous thromboembolism, pneumonia, renal failure/insufficiency, surgical site infection, urinary tract infections, and sepsis), weight-bearing on postoperative day 1, discharge destination, place of residence at 30 days after the operation, days from operation to discharge, readmission related to the index procedure, any readmission, revision surgery, and mortality. Results: Of the 3,244 cases identified for the study, 2,521 (77.7%) underwent intramedullary nailing (IMN). Based on adjusted multivariable analysis, surgical complications between the two intervention groups were not statistically significantly (odds ratio [OR] 1.142; confidence interval [CI], 0.838 to 1.558; P = 0.4). However, patients who underwent IMN were associated with higher rates of blood transfusions (OR, 1.35, CI, 1.042 to 1.748, P = 0.023), more likely discharged to a place other than home (OR, 1.372, CI, 1.106 to 1.700, P = 0.004), and more likely to get Aria Darius Darbandi, BS

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…The studies that compare different types of extramedullary and intramedullary implants report facilitators of weight bearing favouring PFNA-II (compared with dynamic hip locking plates (DHLP)) [95], PFNA (compared with DHS) [52,65,72,94,96], PFN (compared with DHS) [68,76,77], short PFN (compared with DHS) [78], Mini-invasive static nail (compared with conventional DHS) [56], and gamma nail (compared with DHS) [71]. No difference between extramedullary and intramedullary implants was reported in two studies [54,85].…”

“…Okkaoğlu 2020 [79] − Tao 2013 [97] ✓ (B) Shu 2020 [84] ✓ (A) Peyser 2007 [80] ✓ (B) Torres 2014 [92] ✓ (B) Lunsjo 1999 [73] ✓ (D) Xie, 2017 [95] ✓ (B) Leung 1992 [71] ✓ (B) Duymus 2019 [58] ✓ (B) Kamboj 2019 [68] ✓ (B) Mayi 2016 [76] ✓ (B) Meesala 2018 [77] ✓ (B) Huang 2017 [65] ✓ (B) Chen 2018 [52] ✓ (B) Li 2018 [72] ✓ (B) Wang 2019 [94] ✓ (B) Xu 2018 [96] ✓ (B) Nargesh 2013 [78] ✓ (B) Singh 2021 [85] − Darbandi 2022 [54] − Dujardin 2001 [56] ✓ (B) Sandhu 2019 [82] ✓ (B) Jianbo 2019 [66] ✓ (A) Kaneko 2004 [69] ✓ (A) Karaali and Ciloglu 2021 [70] ✓ (B)…”

Comparing Intramedullary Nails Versus Dynamic Hip Screws in the Treatment of Intertrochanteric Hip Fractures on Post-operative Rehabilitation Outcomes:A Systematic Review Protocol

“…In principle, IM Nail is a stronger construct than the DHS fixation. 4 Therefore, many authors have suggested that DHS fixation can be used for most stable intertrochanteric fractures 5 but more unstable patterns should be treated by IM Nail. 6 Interestingly, several studies demonstrate that even the treatment of unstable fracture patterns using DHS has equal success rates of proper healing and therefore IM Nail fixation is not superior in stable or unstable fracture patterns.…”