Purpose: There is a clinical equipoise in regard to the optimal surgical technique for managing trochanteric hip fractures (THFs), while the use of intramedullary (IM) nailing has increased relative to the sliding hip screw (SHS). The purpose of the current investigation was to determine if there is a difference in the risk of postoperative mortality when comparing the 2 techniques in the treatment of THF.
Methods: All consecutive surgically treated THF cases recorded in a national database between 2008 and 2017 were included. Pathological fractures or patients <60 years of age were excluded. Patients were grouped based on the surgical technique employed: SHS or IM nail. This dataset was cross-referenced with 2 other nationwide registers in order to retrieve comorbidity and mortality data, up to 1 year. Poisson regression, adjusting for demographic and clinical covariates, was used to evaluate the association between surgical intervention and mortality.
Results: A total of 46,121 cases were included. 25,877 patients received an SHS and 20,244 received an IM nail. Patients in the IM group were more often female (71.8% vs 69.2%, P<0.001), less fit for surgery (American Society of Anesthesiologists [ASA] class ≥3: 61.2% vs 60.1%, P = 0.003), and more frail (orthopaedic frailty score ≥2: 54.2% vs 52.8%, P = 0.005). Multifragment fractures were also more prevalent in this cohort (66.6% vs 32.0%, P<0.001) and these patients suffered from a higher comorbidity burden. After adjusting for potential confounders no clinically significant differences in 7-day, 30-day, 90-day, or 1-year postoperative mortality was observed when comparing SHS to IM nailing. Subgroup analyses focusing on 2-fragment and multifragment fractures in isolation also could not detect any difference in mortality. A clinical difference was found regarding length of stay in hospital, 1-day mean shorter for the IM nail group.
Conclusion: In this large retrospective cohort study based on 10 years of data and 46,121 THF patients managed with SHS or IM nail, no statistically significant difference was observed in mortality up to 1 year postoperatively, when comparing surgical technique.
