Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons

Abstract

Background The best treatment for intertrochanteric hip fractures is controversial. The use of cephalomedullary nails has increased, whereas use of sliding hip screws has decreased despite the lack of evidence that cephalomedullary nails are more effective. As current orthopaedic trainees receive less exposure to sliding hip screws, this may continue to perpetuate the preferential use of cephalomedullary nails, with important implications for resident education, evidence-based best practices, and healthcare cost. Questions/purposes We asked: (1) What are the current practice patterns in surgical treatment of intertrochanteric fractures among orthopaedic surgeons? (2) Do surgical practice patterns differ based on surgeon characteristics, practice setting, and other factors? (3) What is the rationale behind

Proximal femoral nails anti-rotation versus dynamic hip screws for treatment of stable intertrochanteric femur fractures: an outcome analyses with a minimum 4 years of follow-up

“…Some randomized clinical trials (RCTs) found no difference of implants in long-term functional outcome between the two devices [3–6]. Bhandari et al [7] reported that there were no large differences in IFF risk between the DHS and the PFNA.…”

Is calcar referenced tip-apex distance a better predicting factor for cutting out in biaxial cephalomedullary nails than tip-apex distance?

“…Our main reason for pursuing the use of short PFN was due to ease of insertion and reduced risk of femoral fracture. 9,12 A total of three previous studies found high TAD values to be a significant predictor of cutout in CM nails . 1,13,14 Yet more recent studies suggest that the cutout complication is very low even in patients with high TAD, if the lag screw was positioned inferior in the head and neck.…”

“…Moreover, though without literature support, many orthopedic surgeons believe CM nails are a superior construct to sliding hip screws. 9 This may be due to a shorter operating time, reduced visible intraoperative blood loss, and improved walking ability in unstable hip fractures associated with CM nail. 1 Current CM concepts may be classified as monoaxial and biaxial.…”

“…Though more commonly used, even with the latest monoaxial fixation system, the problem of implant perforation is still not resolved. 9,10 In a finite element analysis by Helwig et al, three monoaxial systems (PFN-A, gamma nail, gliding nail) were compared to a biaxial system (Targon PF) with regard to distributions of stress and strain on the fracture surfaces, investigating both cranial and caudal implant positions. The authors reported that only the biaxial system demonstrated better fracture healing conditions in the cranial position and some advantages in the caudal position.…”

Editorial: How Does CORR ® Evaluate Survey Studies?

“…But we can imagine-and have published-exceptions to this. We recently published a practice-pattern survey demonstrating that an important element of fracture care in practice deviates from solid clinical evidence [5]; in the future, we might also consider practice-pattern surveys that present some unexpected or counterintuitive findings, but by definition such studies are likely to be rare. [6], and ''Do Orthopaedic Surgeons Acknowledge Uncertainty?''…”