Mortality Outcomes in Treating Intertrochanteric Hip Fractures Using Intramedullary Nails and Dynamic Hip Screw: A Retrospective Study

Objective: We aimed to investigate the increased mortality associated with intramedullary nails (IMN) as compared to dynamic hip screws (DHS) in treating trochanteric hip fractures in the elderly population.[1] Method: We conducted a retrospective study on 264 (n=264) patients operated in 2018-2019 at the department of orthopedics University Hospital Waterford. The study was conducted from August 01, 2023, till 01 November 2023. We used data from the Irish hip fracture database (IHFD) for the patient’s biodata, date of surgery and laterality. The national integrated management system (NIMS) tool was used for the interpretation of hip X-rays while inpatient management system (IPMS) software was used for checking the date of mortality. Patient biodata, type of fracture using Arbeitsgemeinschaft für osteosynthesefragen (AO) classification,[2] American society of anesthesiologists (ASA) grading, average time to surgery, reoperation and average time to reoperation were also included as a part of the study.[3] Results: This study confirms that there is a 13% increase in the risk of mortality with IMN compared with a DHS in the treatment of trochanteric hip fractures. Out of the nails, mortality in long nails was 23% greater than in short IMN. The reoperation rate was 20% higher in DHS as compared to nails; however, the time to reoperation was earlier in IMN as compared to DHS (28%). It was clear that AO Type 2.1 was associated with a higher reoperation rate (44%). The most common fracture pattern was AO Type A1.2 (23%) while the least seen pattern was AO Type A3.2 (2%). The average waiting time to operate was 46% more in DHS as compared to nails. The age group was between 60 – 99 years and peak incidence of the fracture was observed between 80-92 years. Most of the patients were female n=174 (66%), and nearly half of the male population n=90 (34%). Most of the patients had ASA grade II (29%) for nails, 38% for DHS and ASA grade III (61%) for nails and (48%) for DHS. Conclusion: It is clear from the study that nails have higher mortality than DHS, especially the long nails which is concordant with Swedish and United kingdom (UK) studies on the same.[6] However, larger-scale studies are needed to further strengthen this hypothesis. DHS has a higher reoperation rate but,[5] it takes a longer time for DHS to reoperate as compared to nails. Since there is little scientific evidence to support the use of nails over DHS, the current use of using IMN rather than DHS may not be fully justified.[4]