Related Experiment Video
Updated: Jun 14, 2025
An Intramedullary Locking Nail for Standardized Fixation of Femur Osteotomies to Analyze Normal and Defective Bone Healing in Mice
Published on: November 13, 2016
Treatment Outcomes of Dynamic Hip Screws Versus Short Intramedullary Nails for Extra-capsular Fragility Hip Fractures
Tarik Al-Dahan1, Siddhartha Murhekar2, Nimesh Patel3
1Trauma and Orthopaedics, East Kent Hospitals University NHS Foundation Trust, Canterbury, GBR.
Insights
Short intramedullary (IM) nails for hip fractures led to faster hospital discharge compared to dynamic hip screws (DHS). This study suggests IM nails may offer benefits, though larger trials are needed.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Geriatric Medicine
Background:
- Hip fractures are a significant cause of emergency department visits in the UK, straining hospital resources.
- The choice of implant for treating extracapsular hip fractures impacts patient outcomes.
Purpose of the Study:
- To compare patient outcomes between dynamic hip screws (DHS) and short cephalomedullary nails for extracapsular hip fractures.
- To identify differences in recovery and mortality rates associated with each implant type.
Main Methods:
- Retrospective study of 52 patients with extracapsular hip fractures treated at an NHS trust.
- Data collected from patient records, including fracture classification and implant type.
- Comparison of variables such as discharge time, 30-day mortality, and operating time.
Main Results:
- Patients treated with short intramedullary (IM) nails had a significantly faster average hospital discharge (8.4 days) compared to dynamic hip screws (DHS) (11 days) (P=0.03).
- 30-day mortality rates were similar: 7% for short IM nails and 6% for DHS (P=0.69).
- Mean operating times were comparable: 58.03 minutes for short IM nails and 58.11 minutes for DHS (P=0.98).
Conclusions:
- Short IM nails are associated with quicker hospital discharge, potentially due to reduced postoperative pain.
- While IM nails offer mechanical advantages and are used for complex fractures, outcomes were similar to extramedullary devices in this study.
- Larger randomized trials are recommended to confirm findings and mitigate potential bias in retrospective studies.
Abstract:
Introduction In the UK, hip fractures are a common reason for presentations to the emergency departments, which places significant pressure on NHS hospitals, appropriate choice of an implant to treat the hip fracture is one among many other factors that affect patients' outcomes. This audit aims to identify and compare the outcome difference between the dynamic hip screws (DHS) and short cephalomedullary nails in the treatment of extracapsular hip fractures. Methods In a retrospective study of 52 patients admitted as a result of hip fractures in one NHS trust, data collection was done from the patients' records using the trust's online system, we studied different variables to compare the outcome difference between DHS and short intramedullary (IM) nails, two senior authors interpreted the patients' X-rays and verified the coding and classification of the neck of femur fractures. Results This retrospective study examined 52 extracapsular hip fracture cases, including 37 females and 15 males. Forty-six (88%) of the included patients were ASA 3 and 4 (American Society of Anesthesiologists), and the average days to discharge from therapies were 8.4 (SD-+ 4) days compared to 11 (SD-+ 5.2) days for short IM nails and DHS, respectively (P= 0.03), the 30-day mortality rate for short nails was 7% (n= 4/52) patients and 6% (n= 3/52) for DHS (P =0.69). The mean operating times for the different implants were 58.11 (SD-+ 15.1) minutes for DHS and 58.03 (SD-+ 23.2) minutes for the short nail (P =0.98). Compliance with the national guidelines for providing an appropriate operation to treat hip fractures initially went from 63% (n=33/52) initially to 73% (n=38/52). This means that more patients who are appropriate for nailing are being treated with IM nails. Conclusion Short IM nails are associated with faster hospital discharge; this fact may be reflecting the lower postoperative pain as a result of avoiding soft tissue dissection associated with extramedullary devices. keeping in mind that IM devices have mechanical advantages over sliding hip screws; hence, they are more commonly used for more complex fracture patterns, leading to nearly similar outcomes when compared to extramedullary devices, this can be a source of bias in retrospective studies, larger randomized trials may lead to different outcomes.
