PURPOSE: The treatment of pertrochanteric fractures is constantly evolving and surgical issues remain controversial. Although the use of a sliding hip screw is considered to be the treatment of choice by many surgeons, we believe that intramedullary nailing could be a viable treatment option for unstable pertrochanteric fractures. Given this background, we compared the clinical outcome of unstable pertrochanteric fractures treated with intramedullary hip screw (IMHS) and standard screws with unstable pertrochanteric fractures treated with intramedullary hip screw using hydroxyapatite (HA)-coated screws.

METHODS: Forty consecutive female osteoporotic patients with pertrochanteric fractures were selected. The inclusion criteria were: female; age ≥65 years; pertrochanteric fracture resulting from minor trauma. Patients were randomized by a computer-generated list to receive either IMHS fixed with stainless steel lag screws (Group A) or IMHS fixed with HA-coated pins (Group B).

RESULTS: Average patient age was 82 ± 8 years in Group A and 78 ± 6 years in Group B. Average BMD was 512 ± 177 in Group A, and 471 ± 231 in Group B. Average intraoperative time was 64 ± 6 minutes in Group A and 34 ± 5 minutes in Group B (p < 0.005). In Group A, all patients had post-operative blood transfusions averaged 2.0 ± 0.1. In Group B, there were no blood transfusions (p < 0.0001). In Group A, the reduction over time in the femoral neck-shaft angle was 6 ± 8, while in Group B, the reduction was 2 ± 1 (p < 0.002).

Conclusion: This study showed that intramedullary hip screw with HA-coated lag screw is an effective treatment for unstable fractures in this patient population. The operative time is brief, the fixation is adequate, and the reduction is maintained over time.