The Journal of Bone and Joint Surgery (American). 2005;87:753-759.
doi:10.2106/JBJS.D.01789
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Dynamic Hip Screw Compared with External Fixation for Treatment of Osteoporotic Pertrochanteric Fractures

A Prospective, Randomized Study

Antonio Moroni, MD1, Cesare Faldini, MD1, Francesco Pegreffi, MD1, Amy Hoang-Kim, BSCH1, Francesca Vannini, MD1 and Sandro Giannini, MD1

1 Department of Orthopaedic Surgery, Bologna University, Rizzoli Orthopaedic Institute, Via G.C. Pupilli, 1, 40136 Bologna, Italy. E-mail address for A. Moroni: a.moroni{at}ior.it

Investigation performed at the Department of Orthopaedic Surgery, Bologna University, Rizzoli Orthopaedic Institute, Bologna, Italy

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).

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.

Background: Although the use of a sliding hip screw is considered to be the preferred treatment for pertrochanteric femoral fractures, we theorized that external fixation could produce clinical outcomes equal to, if not better than, the outcomes obtained with conventional treatment. Furthermore, because external fixation is minimally invasive, we expected a lower rate of morbidity and a reduced need for blood transfusions. Therefore, we compared the two treatments in a clinical trial of elderly patients with pertrochanteric fracture.

Methods: Forty consecutive elderly female patients who had a pertrochanteric fracture were randomized to be treated with either fixation with a 135° four-hole sliding hip screw (Group A) or an external fixation device with hydroxyapatite-coated pins (Group B). The inclusion criteria were female gender, an age of at least sixty-five years, an AO/OTA type-A1 or A2 fracture, and a bone mineral density T-score of less than -2.5. There were no differences in patient age, fracture type, bone mineral density, comorbidities, length of hospital stay, or quality of reduction between the two groups.

Results: The average intraoperative time (and standard deviation) was 64 ± 6 minutes in Group A and 34 ± 5 minutes in Group B (p < 0.005). The average number of units of blood transfused postoperatively was 2.0 ± 0.1 in Group A and none in Group B (p < 0.0001). Group B had less pain five days postoperatively (p < 0.05). Varus collapse of the fracture at six months averaged 6° ± 8° in Group A and 2° ± 1° in Group B (p < 0.002). No pin-track infections occurred in Group B. The average Harris hip score at six months was 62 ± 19 points in Group A and 63 ± 17 points in Group B.

Conclusions: This study showed that external fixation with hydroxyapatite-coated pins is an effective treatment for this fracture in this patient population. The operative time is brief, the blood loss is minimal, the fixation is adequate, and the reduction is maintained over time.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

Read all Letters to the Editor

External Fixation versus Dynamic Hip Screw for Pertrochanteric Fractures
MANOJ TODKAR
JBJS Online, 8 Jun 2005 [Full text]
Dr Moroni et al respond to Dr. Todkar
Antonio Moroni, et al.
JBJS Online, 8 Jun 2005 [Full text]
"Dynamic Hip Screw Compared with External Fixation for Treatment of Osteoporotic Pertrochanteric Fra
Rahij Anwar, et al.
JBJS Online, 16 Jun 2005 [Full text]
A Response by Dr. Moroni to the on line JBJS Commentary and Perspective by Dr. Marsh
Antonio Moroni, M.D.
JBJS Online, 26 Jul 2005 [Full text]