1: J Bone Joint Surg Am  1998 May;80(5):618-30 Comment in: J Bone Joint Surg Am. 1999 Oct;81(10):1502-3.Use of an intramedullary hip-screw compared with a compression hip-screw with aplate for intertrochanteric femoral fractures. A prospective, randomized studyof one hundred patients.Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, Delince PE.Department of Orthopaedic Surgery, University Hospital Saint-Pierre, Brussels,Belgium.One hundred elderly patients who had an intertrochanteric femoral fracture wererandomized to treatment with a compression hip-screw with a plate (fiftypatients) or a new intramedullary device, the intramedullary hip-screw (fiftypatients). All patients were followed prospectively for one year or until death.A detailed assessment of the functional status and the plain radiographs of thehip was performed one, three, six, and twelve months postoperatively. The twotreatment groups were strictly comparable. The operative time needed to insertthe intramedullary hip-screw was significantly greater than that needed toinsert the compression hip-screw with the plate (p = 0.02), but use of theintramedullary hip-screw was associated with less estimated intraoperative bloodloss (p = 0.011). The prevalence of perioperative complications, such asbronchopneumonia, cardiac failure, and urinary tract infection, was comparablein the two treatment groups. There were one intraoperative fracture of thefemoral shaft and two intraoperative fractures of the greater trochanter in thegroup managed with the intramedullary hip-screw. One patient had pulling-out ofthe compression hip-screw on the seventh postoperative day. Four patients had atrochanteric wound hematoma, without infection, after insertion of anintramedullary hip-screw. All but one of the fractures healed. The onenon-union, which was in a patient who had a compression hip-screw, was treatedwith a hemiarthroplasty. The mortality rate was similar in the two treatmentgroups. The patients who had an intramedullary hip-screw had, on the average,significantly better mobility at one (p < 0.0001) and three months (p = 0.0013)postoperatively. This difference was no longer seen at six and twelve months,although the patients who had an intramedullary hip-screw still hadsignificantly better walking ability outside the home at those time-periods (p =0.05). The compression hip-screw was removed from two patients because of painin the mid-portion of the thigh, which had begun after consolidation of thefracture. Fourteen patients who had an intramedullary hip-screw had corticalhypertrophy at the level of the tip of the nail at twelve monthspostoperatively. Cortical hypertrophy was significantly related to the use oftwo interlocking screws (p = 0.02). Six of these patients also had pain in themid-portion of the thigh, and the nail had been locked with two screws in fiveof them. Three of the six patients had the hardware removed because of the pain,and the symptoms resolved. A seventh patient had pain without corticalhypertrophy. The intramedullary hip-screw device was associated withsignificantly less sliding of the lag-screw and subsequent shortening of thelimb in the region of the thigh (p = 0.012 and 0.019, respectively); thesedifferences were more pronounced when the unstable fractures in the twotreatment groups were compared (p < 0.001).Publication Types:Clinical TrialRandomized Controlled TrialPMID: 9611022 [PubMed - indexed for MEDLINE]