Objectives: In the treatment of closed intertrochanteric fractures, the two most common treatment
options are intramedullary medullary nail (IMN) and dynamic hip screw (DHS), yet the best treatment
method remains controversial. The purpose of this study is to determine the difference in mortality and
morbidity between IMN and DHS. Secondarily, this study determines which pre -operative risk factors
affect rates of morbidity and mortality.
Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2006-2016
database was used to search for patients with a closed intertrochanteric hip fracture. Bivariate analysis was
performed using Pearson’s Chi Square test to determine pre-operative risk factors associated with complications in
fixation with IMN and DHS. Significant variables in this analysis, as well as demographic data, were analyzed via
binary logistic regression. The results were recorded as odds ratio (OR) and significant differences were based on
a P<0.05.
Results: After adjusting for demographics and clinical covariates, patients who underwent fixation with IMN had
higher 30-day mortality, reintubation, UTI, bleeding, prolonged length of stay, and non-home discharged destination
rates compared to DHS. Mortality risk was increased by ascites, disseminated cancer, impaired functional status,
history of congestive heart failure, and hypoalbuminemia. Bleeding risk was increased by previous percutaneous
coronary (PCI) and transfusions and was decreased by impaired functional status. Myocardial infarction risk was
increased by female gender.
Conclusion: Our study found that IMN fixation increased risk of mortality, UTI, reintubation, bleeding, prolonged
length of stay, and a non-home discharge destination compared to DHS. This study also identified patient risk factors
associated with several postoperative complications. These data may better inform orthopaedic surgeons treating
closed intertrochanteric fractures.
Level of evidence: III |
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