With its lower complication rate in comparison with intramedullary nails, and absence of functional outcome data to the contrary, the SHS appears superior for trochanteric fractures. Further studies are required to confirm whether more recently developed designs of intramedullary nail avoid the complications of previous nails. Intramedullary nails may have advantages over fixed angle plates for subtrochanteric and some unstable trochanteric fractures, but further studies are required.
Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.
One hundred thirty-one patients (135 fractures) who sustained an intertrochanteric fracture were assigned randomly to treatment with either a sliding hip screw or an intramedullary hip screw and followed up prospectively. In patients with unstable intertrochanteric fractures, the intramedullary device was associated with 23% less surgical time and 44% less blood loss; however, use of the intramedullary hip screw in patients who had a stable fracture pattern required 70% greater fluoroscopic time. Intraoperative complications occurred exclusively in patients in the intramedullary hip screw group. There were no differences in the rates of functional recovery between the two fixation groups.