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Intertrochanteric Hip Fractures: An Audit of Surgical Fixation Technique and Rates of Revision

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Intertrochanteric hip fractures: an audit of surgical fixation technique and rates of revision

A Bilkhu, H Phillips, G Sisodia, KP Muralikuttan

Department of Trauma & Orthopaedics, Calderdale & Huddersfield NHS Trust

 

Background

There remains ongoing debate on the best method to repair intertrochanteric femoral fractures.

 NICE Guidance recommends the use of extra-medullary implants (e.g. sliding hip screw) for AO Types A1 and A2.

 AIMS:

1)To assess compliance of surgical fixation of intertrochanteric fractures with NICE guidance in our trust.
2)To analyse differences in post-operative outcomes and rates of revision between intra-medullary nail and extra-medullary screw fixation.

 

Methods

Retrospective review of all adult intertrochanteric fractures between 1st Jan 2007 to 31st May 2009: fractures blindly and independently classified according to AO classification.

 Data collected:

-Demographics
-Length of stay
-Mortality
-Rates of revision

 

Results

250 of 311 patients were of Fracture type A1 or A2. Only 92 (36.8%) were fixed with a DHS.

No significant difference in post-operative mortality between groups (p>0.05)

 

Conclusions
1) Compliance with NICE guidance only 36.8%
2) No differences in inpatient stay, post-operative mortality or rates of revision between extramedullary and intramedullary fixation.
3) Overall rate of revision – 5.47%.
4) 2.25% of these revisions were due to implant failure

References
1)NICE Guidance: The management of hip fractures in adults
2)A meta-analysis of the Gamma nail and dynamic hip screw in treating peritrochanteric fractures. M Liu, Z Yang, F Pei et al. IntOrthop. 2010 Mar; 34(3): 323-328.

 

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