Trochanteric locking nail versus arthroplasty in unstable intertrochanteric fracture in patients aged over 75 years - 07/09/11

Doi : 10.1016/j.otsr.2011.06.009

P. Bonnevialle ^a,^⁎ , D. Saragaglia ^b, M. Ehlinger ^c, J. Tonetti ^d, N. Maisse ^e, P. Adam ^c, C. Le Gall ^a
French Hip and Knee Society (SFHG), Traumatology Study Group (GETRAUM)
^a Locomotor System Institute, Toulouse University Hospital Center, Purpan Traumatologic Orthopedics Unit, place Baylac, 31052 Toulouse cedex, France
^b Orthopedics and Sports Traumatology Academic Clinic, Grenoble University Hospital Center, hôpital Sud, 38130 Échirolles, France
^c Orthopedic and Traumatologic Surgery Dept, Hautepierre Hospital, 67098 Strasbourg cedex, France
^d Orthopedics-Traumatology Academic Clinic, Grenoble University Hospital Center, Hôpital Nord, 38700 La Tronche, France
^e Lille Regional University Hospital Center, Traumatology Dept, 59037 Lille cedex, France

Corresponding author.

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Summary

Introduction

In trochanteric fracture, whatever its anatomic type, internal fixation is currently the standard attitude, with arthroplasty as a relatively unusual option.

Hypothesis

Hip implants are an excellent alternative to osteosynthesis in unstable trochanteric fracture in patients aged over 75 years.

Patients and methods

A non-randomised prospective multicenter study compared osteosynthesis by trochanteric nailing (n=113) to hip arthroplasty (n=134) in unstable trochanteric fracture (AO types 31 A2.2 and 3 and A3.3) in 247 patients over the age of 75 years. The series was recruited during 2007 in seven centres, four of which included only arthroplasties, two only osteosyntheses and one both. The two groups were comparable in age, sex, preoperative Parker score, pre-fracture place of residence, fracture type, time to surgery and preoperative comorbidity. The sole difference was in operators, with more senior surgeons in arthroplasty (62% versus 27%).

Results

Three-month mortality was identical in the two groups (21.2% versus 21%). General complications did not differ, although mechanical complications were more frequent in the nailing group (12.5% versus 2.8%). Functional results (Parker and PMA scores) were better in the implant than in the nail group.

Discussion

The present study validated hip arthroplasty in these indications. Cemented stems associated to a dual-mobility acetabular component gave the best results.

Type of study

Prospective, level of evidence III.

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Keywords : Trochanteric fracture, Proximal femoral extracapsular fracture, Hip arthroplasty, Trochanteric locking nail

Plan

Disclosure of interest

The GETRAUM and SFHG, two SoFCOT affiliate societies, met to discuss a shared topic of interest at the interface between the elective orthopaedics and traumatology. The present article is the result of this study.