The Orthopaedic Traumatologist and the Peritrochanteric Hip Fracture-Does Experience Matter?

The purpose of this study was to review our protocol of sliding hip screws for stable and cephallomedullary devices for unstable peritrochanteric fractures to evaluate the correctness of the decisions made based on complication rates and on shortening of the fractures as well as financial implications. Over a five-year period, two orthopaedic traumatologists followed a protocol utilizing a sliding hip screw (SHS) for all fractures that were deemed stable and a cephallomedullary nail for unstable fractures. Injury radiographs were then re-reviewed by a blinded observer to classify each fracture pattern as stable or unstable based on the Evans classification. Of 121 patients, 62 were classified as stable and 59 unstable. The tip apex distance averaged 16 mm with 2/61 (3.3%) > 25mm for plates and 22 mm with 6/60 (10%) > 25mm for intermedullary (IM) nails. Two partial cutouts occurred, both in the SHS group. Minimal shortening and deformity were noted for each group. A stability-based protocol utilizing sliding hip screws for stable and IM nails for unstable peritrochanteric hip fractures based on the judgment of experienced surgeons is valid and reasonable, resulting in significant savings compared to using IM nails for all cases ($104,898 in this series). (Journal of Surgical Orthopaedic Advances 30(3):140-143, 2021).