Clinical Outcomes of Intramedullary and Extramedullary Fixation in Unstable Intertrochanteric Fractures: A Randomized Clinical Trial

Abstract

Background: The best method for repairing intertrochanteric fractures is still controversial. The fixation methods include<br />extramedullary (EM) and intramedullary (IM). Studies that compare IM and EM fixations for unstable hip fractures are<br />rare. In this study, our goal was to compare the efficacy of EM and IM fixation in treatment of unstable intertrochanteric<br />fractures.<br />Methods: A total of 113 patients with unstable intertrochanteric were randomized in this cohort study between March<br />2016 and June 2018 in trauma center of Kashani and Alzahra Hospitals, Isfahan, Iran. The patients were followed for a<br />period of 12 months with sequential clinical and imaging evaluations. Baseline data were recorded at the time of injury.<br />Radiographs were evaluated immediately post-operatively and at the scheduled follow-up intervals.<br />Results: A total of 20 of patients were excluded during the study and finally 93 patients (43 males and 50 females)<br />with mean age of 62.74±16.4 completed the follow-up sessions. Mann-Whitney test indicated a significant difference in<br />tip-apex distance between the two groups. While the two groups were homogeneous in the baseline LEM score, it was<br />not significantly different between two groups after 1 and 3 months of surgery as well. However, the LEM score was<br />significantly higher in IM group after 6 and 12 months of surgery.<br />Conclusion: According to our findings, IM nails (such as the cephalomedullary nail) afforded more advantages over<br />EM devices (such as the DHS and DCS) in the treatment of unstable intertrochanteric fractures. Our results indicated<br />that the final LEM scores as well as the time to union were better in IM fixation group.<br />Level of evidence: I