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The Journal of Bone and Joint Surgery (American) 84:372-381 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Treatment of Reverse Oblique and Transverse Intertrochanteric Fractures with Use of an Intramedullary Nail or a 95° Screw-Plate

A Prospective, Randomized Study

Christophe Sadowski, MD, Anne Lübbeke, MD, Marc Saudan, MD, Nicolas Riand, MD, Richard Stern, MD and Pierre Hoffmeyer, MD

Investigation performed at the Orthopaedic Service, University Hospital of Geneva, Geneva, Switzerland

Christophe Sadowski, MD
Anne Lübbeke, MD
Marc Saudan, MD
Nicolas Riand, MD
Richard Stern, MD
Pierre Hoffmeyer, MD
Clinique d’Orthopédie et de Chirurgie de l’Appareil Moteur, Hôpital Cantonal Universitaire, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail address for N. Riand: nicolas.riand@hcuge.ch. E-mail address for R. Stern: richard.stern{at}hcuge.ch E-mail address for P. Hoffmeyer: pierre.hoffmeyer@hcuge.ch

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Intertrochanteric fractures are composed of different anatomic patterns that vary in their degree of stability following open reduction and internal fixation. A particularly unstable group is classified as AO/OTA 31-A3, with the fracture pattern described as reverse oblique or transverse. The purpose of this study was to compare the results of intramedullary fixation with those of plate fixation for these intertrochanteric fractures in elderly patients.

Methods: Thirty-nine elderly patients with AO/OTA 31-A3 intertrochanteric fractures of the femur were randomized into two treatment groups and were followed for a minimum of one year. The nineteen patients in Group I were treated with a 95° fixed-angle screw-plate (Dynamic Condylar Screw), and the twenty patients in Group II were treated with an intramedullary nail (Proximal Femoral Nail). The treatment groups were comparable with regard to all demographic and injury variables.

Results: Patients treated with an intramedullary nail had shorter operative times, fewer blood transfusions, and shorter hospital stays compared with those treated with a 95° screw-plate. Implant failure and/or nonunion was noted in seven of the nineteen patients who had been treated with the 95° screw-plate. Only one of the twenty fractures that had been treated with an intramedullary nail did not heal.

Conclusion: The results of our study support the use of an intramedullary nail rather than a 95° screw-plate for the fixation of reverse oblique and transverse intertrochanteric fractures in elderly patients.


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