Higher 30-day mortality associated with the use of intramedullary nails compared with sliding hip screws for the treatment of trochanteric hip fractures: a prospective national registry study

Journal article

Aims The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality.

Patients and Methods Data on 82 990 patients from the National Hip Fracture Database were analyzed using generalized linear models with incremental case-mix adjustment for patient, non-surgical and surgical characteristics, and socioeconomic factors.

Results The use of short and long intramedullary nails was associated with an increase in 30-day mortality (adjusted odds ratio (OR) 1.125, 95% confidence interval (CI) 1.040 to 1.218; p = 0.004) compared with the use of sliding hip screws (12.5% increase). If this were causative, it would represent 98 excess deaths over the four-year period of the study and one excess death would be caused by treating 112 patients with an intramedullary nail rather than a sliding hip screw.

Conclusion There is a 12.5% increase in the risk of 30-day mortality associated with the use of an intramedullary nail compared with a sliding hip screw in the treatment of a trochanteric fractures of the hip.

Authors: Whitehouse, MR; Berstock, JR; Kelly, MB; Gregson, CL; Judge, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone and Joint Surgery
• Journal: Bone and Joint Journal
• Volume: 101-B
• Issue: 1
• Pages: 83-91
• Publication date: 2019-01-01
• Acceptance date: 2018-10-26
• DOI: 10.1302/0301-620x.101b1.bjj-2018-0601.r2
• EISSN: 2049-4408
• ISSN: 2049-4394
• Pmid: 30601043
• Language: English
• Keywords: sliding hip screw; neck of femur fracture; mortality; National Hip Fracture Database; trochanteric hip fracture; intramedullary nail