Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail?

Abstract

Purpose:The purpose of this study is to investigate the constant necessity of distal locking when intertrochanteric fracture was treated with an intramedullary hip nail. Materials and Methods: From April 2010 to June 2013, 47 stable intertrochanteric fractures (AO/OTA 31-A1) were treated with second generation intramedullary hip nailing. They were followed-up for more than 12 months. In the first group of 18 cases distal locking was used, and in the second group of 29 cases, distal locking was not used. We compared the radiologic and clinical results of the two groups. Results: Comparison of the two groups of patients showed no difference in terms of radiological and functional results. Postoperative thigh pain developed in eight cases (17%). A statistically difference was observed between isthmic diameter and used nail diameter (Fisher exact test, p=0.01) for postoperative thigh pain. In logistic regression analysis, the difference between isthmic diameter and used nail diameter was the most statistically significant factor in development of postoperative thigh pain (p=0.04, odd ratio=27.75). Conclusion: Our results suggested that the second generation intramedullary hip nail may be successfully implanted without distal interlocking in 31-A1 intertrochanteric femur fracture when the reduction status was satisfactory and stable fixation of the distal area was estimated by less than 3 mm difference between isthmic diameter and used nail diameter.

Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

“…Another 10 unrelated biomechanical studies were excluded after further reading. Finally, 9 studies (4 randomized controlled trials [12][13][14][15] and 5 observation studies [16][17][18][19][20]) met our inclusion and exclusion criteria, including 7 in English [12][13][14][16][17][18][19], 1 in Spanish [15], and 1 in Korean [20] (Fig. 1).…”

“…2). The 5 cohort studies [16][17][18][19][20] were considered of relatively high quality because of a score ≥ 7 according to the NOS scale criteria ( Table 2).…”

“…Duration of the operation, intraoperative blood loss, transfusion rate, and fluoroscopy time were recorded. Seven studies [12][13][14][15][16][17]20] provided data regarding the duration of the operation. The data showed a significant difference in the duration of the operation between the two groups, and the average operation time when distal unlocking was performed was shorter when compared to that needed for performing distal locking (mean difference: 7.04, 95% CI: 4.42-9.67, P < 0.00001) ( Fig.…”

“…Five studies [12][13][14][15]20] provided data regarding intraoperative blood loss. The data showed that average intraoperative blood loss when distal unlocking was performed was less when compared to that after during distal locking (mean difference: 28.71, 95% CI: 8.55-48.87, P=0.005) ( Fig.…”

“…All nine studies [12][13][14][15][16][17][18][19][20] provided data regarding complications. Statistically significant differences were not observed between distal locking and distal unlocking in total complications and subgroups, such as hematoma, deep vein thrombosis, avascular necrosis of the femoral head, and infection.…”