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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



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.


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.



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:

-Length of stay
-Rates of revision



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)


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

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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