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Comparison between locked and unlocked intramedullary nails in intertrochanteric fractures

  • Riccardo Maria Lanzetti
  • Auro Caraffa
  • Domenico Lupariello
  • Paolo Ceccarini
  • Giulio Gambaracci
  • Luigi Meccariello
  • Francesco Manfreda
  • Daniele Maiettini
  • Cristina Ibáñez Vicente
  • Michele Scialpi
  • Olga Bisaccia
  • Giuseppe Rinonapoli
  • Michele Bisaccia
Original Article • HIP - TRAUMA

Abstract

Background

Intertrochanteric fractures are of great interest worldwide and are the most frequently operated fractures. Intramedullary nailing is commonly used in the treatment of intertrochanteric fractures. The purpose of this study is to assess the necessity of using the distal blocking screw in 31-A1 and 31-A2 fractures, classified according to the Orthopaedic Trauma Association classification system (AO/OTA).

Methods

This is a prospective study of 143 consecutive patients (mean age 85.01 years, mean final follow-up 14.1 months) surgically treated with the same intramedullary nail. In 75 cases, the distal locking screw was not used. Parameters evaluated during follow-up were: blood loss, transfusion requirements, surgery duration, and fluoroscopy time. Harris Hip Score and Barthel Activity Daily Living were used for the clinical evaluation. Radiographic Union Score For Hip (RUSH score) and Tip apex distance (TAD) were measured for radiologic evaluation.

Results

The group treated without locking screw showed significantly shorter surgical duration time (31.9 vs. 47.2 min), a decrease in blood loss (variation Hb − 1.06 vs. − 1.97), and reduced X-rays exposure time (25.4 vs. 31.6 s). No significant differences were observed in the postoperative period and in the radiographic and clinical scores.

Conclusion

This study demonstrates that in intertrochanteric 31-A1 and 31-A2 stable fractures, the absence of distal locking screw does not compromise bone healing and prevents several clinical complications.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Riccardo Maria Lanzetti
    • 1
  • Auro Caraffa
    • 1
  • Domenico Lupariello
    • 5
  • Paolo Ceccarini
    • 1
  • Giulio Gambaracci
    • 2
  • Luigi Meccariello
    • 3
  • Francesco Manfreda
    • 1
  • Daniele Maiettini
    • 2
  • Cristina Ibáñez Vicente
    • 1
  • Michele Scialpi
    • 2
  • Olga Bisaccia
    • 4
  • Giuseppe Rinonapoli
    • 1
  • Michele Bisaccia
    • 1
  1. 1.U.O.C. Orthopedics and Traumatology Department, SM Misericordia HospitalUniversity of PerugiaPerugiaItaly
  2. 2.Radio-Diagnostic Department, SM Misericordia HospitalUniversity of PerugiaPerugiaItaly
  3. 3.U.O.C. Orthopedics and TraumatologyVito Fazzi HospitalLecceItaly
  4. 4.Radiology Unit, Department of Diagnostic Imaging“Niguarda Ca’ Granda” HospitalMilanItaly
  5. 5.University of Rome, La SapienzaRomeItaly

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