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Dramatic Change in Surgery for Hip Fracture

Posted on: 04/18/2008
The American Board of Orthopaedic Surgery did a study to find out how orthopedic surgeons are repairing intertrochanteric hip fractures. This fracture occurs between two bony knobs on the neck of the femur (thigh bone). They found a big shift has occurred in how this fracture is repaired. The change has taken place in the last five to seven years.

From the 1950s until the early 1990s, the standard procedure for repairing an intertrochanteric hip fracture was with a sliding compression hip screw and side plate. This technique is referred to as plate and screw fixation. However, in the last 10 years, a new fixation device for this type of fracture has been made available.

A short intramedullary nail placed through the greater trochanter (one of the two bony knobs) with an interlocking screw is used much more often now. In fact, the use of this technique called intramedullary nail fixation increased from three per cent in 1999 to 67 per cent in 2006.

It appears that this change has taken place all over the U.S. It started first in the Southeast region. Then finally made its way to the Northwest. Data shows that the complication rate for intramedullary nail fixation has been higher than for the plate and screw method. Fractures are especially more likely to occur during and after intramedullary nail fixation.

The complication rate appears to be declining over time. Surgeons using the technique with more and more patients may be improving with fewer surgical errors. There is a common opinion among orthopedic surgeons that nail fixation is the best way to treat unstable intratrochanteric hip fractures.

However, there isn't enough evidence to really support this conclusion. The results of studies done so far show that the intramedullary nail fixation has more complications and the final results aren't any better than with the plate and screw method. The intramedullary approach is a quicker and easier surgery but the cost is also higher than for the plate and screw fixation.

More evidence-based studies comparing these two methods of surgical repair need to be done.

Jeffrey O. Anglen, MD, and James N. Weinstein, DO. Nail or Plate Fixation of Intertrochanteric Hip Fractures: Changing Pattern of Practice. In The Journal of Bone and Joint Surgery. April 2008. Vol. 90-A. No. 4. Pp. 700-707.

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