Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: Preliminary results

Objectives: This study aimed at comparing the results obtained with a slidi ng screw plate and an experimental device including a small-diameter nail t hat can be placed with a mini-invasive approach and provides a stable fixat ion. Design: Randomized prospective study. Setting: University hospital. Patients: The study included two groups with thirty fractures of the trocha nteric area. Interventions: In both groups, the surgical procedure was carried out on pa tients placed on a traction table in a supine position, under an x-ray ampl ifier. Sliding screw plates (THS) were set in place according to the usual open technique. Nails were placed through a twenty-millimeter supratrochant eric cutaneous incision. This experimental system comprised a locked intram edullary nail with two nonparallel seven-millimeter cervicocephalic screws. Main Outcome Measures: The comparison between the two groups was based on t he surgical procedure (time, duration of x-ray irradiation, and total blood loss); the initial postoperative period (complications, duration of hospit al stay, and the time before returning home); the time before full weight b earing became effective; the functional and social recovery; mortality; and the quality of immediate and final anatomic restitution and healing. Results: Operating time (p < 0.001) and blood loss (p < 0.001) were lower i n the nail group, and no blood transfusion was required. Postoperative pain (p < 0.01), time necessary to support full weight bearing (p < 0.02), and time before returning home (p < 0.05) were reduced in the nail group. All f ractures healed in the same amount of time, with good anatomic results in t he nail group, whereas ten impactions beyond ten millimeters occurred in th e plate group. No difference was found between the two groups in walking ab ility and autonomy recovery, but hip function (p < 0.05) was better in the nail group. Conclusion: This preliminary clinical study has shown the advantages of thi s mini-invasive technique. It could not evaluate all the possible disadvant ages inherent in the method. These points will be evaluated in a multicente r study justified by these preliminary results.