In a randomised trial involving 598 patients with 600 trochanteric fractures of the hip, the fractures were treated with either a sliding hip screw (n = 300) or a Targon PF intramedullary nail (n = 300). The mean age of the patients was 82 years (26 to 104). All surviving patients were reviewed at one year with functional outcome assessed by a research nurse blinded to the treatment used. The intramedullary nail was found to have a slightly increased mean operative time (46 minutes (sd 12.3) versus 49 minutes (sd 12.7), p < 0.001) and an increased mean radiological screening time (0.3 minutes (sd 0.2) versus 0.5 minutes (sd 0.3), p < 0.001). Operative difficulties were more common with the intramedullary nail. There was no statistically significant difference between implants for wound healing complications (p = 1), or need for post-operative blood transfusion (p = 1), and medical complications were similarly distributed in both groups. There was a tendency to fewer revisions of fixation or conversion to an arthroplasty in the nail group, although the difference was not statistically significant (nine versus three cases, p = 0.14). The extent of shortening, loss of hip flexion, mortality and degree of residual pain were similar in both groups. The recovery of mobility was superior for those treated with the intramedullary nails (p = 0.01 at one year from injury).
In summary, both implants produced comparable results but there was a tendency to better return of mobility for those treated with the intramedullary nail.
The authors would like to acknowledge the support of the research nurses M. Norman, K. Ruggiero, N. Smith and D. Parker.
There was no external source of funding for this study. Internal funding was from the Peterborough Hospital Hip Fracture fund.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.
Supplementary material. Three tables showing details of i) the pain score, ii) the mobility score, and iii) the medical complications encountered in both groups are available with the electronic version of this article on our website www.jbjs.org.uk
- Received September 28, 2011.
- Accepted November 8, 2011.
- ©2012 British Editorial Society of Bone and Joint Surgery