Sliding hip screw versus intramedullary nail for trochanteric hip fractures; a randomised trial of 1000 patients with presentation of results related to fracture stability

Aims: To determine the optimum choice of implant for a patient with a the different types of trochanteric hip fracture. Patients and methods: 1000 patients with a trochanteric hip fracture were randomised to internal fixation of the fracture with either a Sliding Hip Screw or an intramedullary nail. Fractures were subdivided into two part fractures, comminuted fractures and fractures at the level of the lesser trochanter (reversed/oblique and transverse). Functional assessment for up to one year from injury was undertaken by a research nurse blinded to the treatment allocation. Results: The mean age of patients was 82 years and 77% were female. There was a significantly improved regain of mobility for those treated with the intramedullary nail. No statistically significant differences between the two types of fixation methods was observed for mortality, fracture healing complications, re-operations, hospital stay, length of surgery, blood transfusion requirements, medical complications, degree of residual pain or regain of independence. These finding were valid for all fracture types. Conclusion: This study is the first adequately powered randomised trial on this topic and demonstrates that there are no notable differences in either process or functional outcomes between these two treatment methods, other than a tendency to better regain of mobility for those fractures fixed with an intramedullary nail. (c) 2017 Elsevier Ltd. All rights reserved.