Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management: The INSITE Randomized Clinical Trial

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Hip fractures significantly impair function and quality of life.
• Intramedullary nails (IMN) are commonly used for trochanteric fractures, but their higher cost and unproven superiority over sliding hip screws (SHS) necessitate further evidence.

Purpose of the Study:

• To compare the 1-year functional and quality-of-life outcomes of patients with trochanteric hip fractures treated with either an IMN or an SHS.

Main Methods:

• A randomized clinical trial involving 850 ambulatory patients with trochanteric fractures across 25 international sites.
• Patients were randomized to receive surgical fixation with either a Gamma3 IMN or an SHS.
• Primary outcome was health-related quality of life (HRQOL) measured by EQ5D at 1 year; secondary outcomes included revision surgery, healing, adverse events, mobility, and hip function.

Main Results:

• No significant differences were observed between the IMN and SHS groups in 1-year EQ5D scores (P=.42).
• Secondary outcomes, including revision surgery, fracture healing, adverse events, mobility, and hip function, also showed no significant between-group differences.
• No significant interactions were found between fracture stability or previous fracture and treatment group.

Conclusions:

• Intramedullary nails (IMN) and sliding hip screws (SHS) demonstrate comparable 1-year outcomes for treating trochanteric hip fractures.
• The sliding hip screw (SHS) represents a viable, lower-cost alternative for the surgical management of these fractures.