Abstract
Objectives: To compare the efficiency of long, locked, trochanteric entry intramedullary nail (Holland nail) against Dynamic Hip Screw in the operative stabilisation of inter-trochanteric femoral fractures.
Study Design: Prospective randomised control study
Method: 190 patients were recruited over 12 months and followed up to fracture union. Patients were randomised into two groups: Holland nail (92) and DHS (98). Variables looked at preoperatively were mini mental test; pre-op mobility; fracture pattern and ASA grading. Operative variables analysed were ease of fracture reduction; surgical time; quality of implant fixation; operative blood loss and radiation time. Post operatively, time to frame; wound problems; time to discharge; rate of fracture union and chronic pain were analysed.
Results: The two study groups were comparable. There was a statistically significant increase in surgical and radiation time with the Holland nail group but this was surgeon dependent. Patients receiving Holland nail had less operative blood loss (p< 0.001). The time to mobility with frame in the Holland nail group was quicker in the fitter patients (ASA 1& 2) (p< 0.005). Holland nail group had lower infection rate (p< 0.01).
Conclusion: Patients with inter-trochanteric fractures who received Holland nail had less blood loss; fewer wound problems; mobilised quicker; had shorter hospital stay and less pain at 6 months compared to patients who had DHS. Fracture union rate was identical in both groups.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
