Mattia Alessio-Mazzola1, Giacomo Traverso2,3, Francesco Coccarello2,3, Francesca Sanguineti2,3,Matteo Formica2,3

1IRCCS Ospedale San Raffaele, Unità Clinica di Ortopedia e Traumatologia, Milano, Italy
2Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genova, Italy
3Orthopedic Clinic, Ospedale Policlinico San Martino, Largo R. Genova, Italy

Keywords: Dynamic hip screw, intertrochanteric fractures, nail, proximal femur, sliding hip screw.


Objectives: This study aims to compare sliding hip screw and intramedullary nail perioperative results and costs in two-part femoral fractures.

Patients and methods: Between January 2015 and December 2019, a total of 85 patients (70 males, 15 females; mean age: 85.6±9.5 years; range, 33 to 99 years) who were treated for intertrochanteric two-part femoral fractures were retrospectively analyzed. The patients were stratified and divided into two groups according to type of implant used for surgical fixation: one group treated with intramedullary proximal femoral nail (EBA) and the other with sliding hip screw (DHS). Comorbidity, hemoglobin level (Hb), hematocrit (hct) level, number of transfusions, and days of hospitalization details were evaluated. Postoperative X-rays were analyzed to assess the quality of reduction and to identify non-union, malunion, mechanical failures, and heterotopic ossifications. The modified Harris Hip Score, fracture mobility score, and Parker Mobility Score were calculated. Cost analysis considered the orthopedic device, operating room, transfusion, and hospital costs for the primary hospital stay.

Results: Of the patients, 44 were treated with DHS and 41 were treated with EBA nail by a single surgeon. No significant differences were found in the baseline demographic data. There was a significant increased operative time (p<0.001) and decreased fluoroscopy X-ray exposure time (p=0.031) in the subgroup of patients who underwent DHS fixation. The patients who underwent EBA nail fixation had a significantly higher transfusion rate during hospitalization (p=0.001) and a significantly lower Hb level and hct level on postoperative Day 1 and Day 3 (p<0.05). There were no significant differences in the clinical and functional scores, radiographic outcomes and mortality (p>0.05). The patients who underwent intramedullary nail fixation had higher costs.

Conclusion: Sliding hip screws showed decreased postoperative anemization, lower transfusion rates, and similar clinical outcomes compared to the intramedullary nail for two-part femoral fractures. Sliding hip screws should be preferred for A1 intertrochanteric fractures.

Citation: Alessio-Mazzola M, Traverso G, Coccarello F, Sanguineti F, Formica M. Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis. Jt Dis Relat Surg 2022;33(2):314-322.

Ethics Committee Approval

This retrospective singlecentre research was approved by the CER Ospedale Policlinico San Martino, Regione Liguria review board (IRB number 252/21). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Draft writer, data analysis, methods and study design: M.A.M.; Data collection, clinical assessment, draft review: G.T.; Data collection, clinical assessment: F.C.; Surgeon: F.S.; Study supervision: M.F.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.