Intertrochanteric fractures: Similar rate of reoperation using fixed or sliding side plate .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(7):39 Injury. 2013 Dec;44(12):1904-9. doi: 10.1016/j.injury.2013.06.017. Epub 2013 Jul 20163 patients with unstable intertrochanteric fractures were randomized to receive surgical treatment using either (1) a sliding hip screw and fixed side plate or (2) a sliding hip screw and a Medoff sliding side plate. The purpose of this study was to compare rates of re-operation and hip function scores following treatment with these two types of hardware. Results after 6 months indicated that the use of a sliding hip screw with a Medoff sliding side plate resulted in a similar re-operation rate, hip function recovery scores, length of hospital stay, haemoglobin drop, number of transfusions, transfusion units, leg-length discrepancy, loss in range of motion, and the incidence of complications. Surgical time was significantly greater in the Medoff sliding side plate group.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
2/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Hip screws are used in the treatment of unstable intertrochanteric hip fractures, however the average failure rate for this treatment remains quite high (15%). As to be expected, this high failure rate may lead to a significantly higher number of re-operations, resulting in increased patient morbidity and health care costs. Previously, when sliding hip screws were introduced into practice, failure rates significantly dropped. Based on this reasoning, it has been suggested that the implementation of both sliding hip screws and sliding plates in the treatment of unstable intertrochanteric hip fractures may result in improved re-operation rates and patient function.
Was war die wichtigste Forschungsfrage?
How does the use of a sliding hip screw and a sliding side plate compare to the use of a sliding hip screw and fixed side plate in the treatment of unstable intertrochanteric fractures, with respect to re-operation rate and patient function assessed at 6 months postoperatively?
- Re-operation rates due to hardware failure were statistically similar between groups (3 in the DHS group [3.7%] and 2 in the MSP group [2.5%]; p>0.05). Two other re-operations were perfomed (both in the DHS group); 1 for wound debridement and 1 for hardware removal.
- 6 patients in the MSP group and 1 patient in the DHS group experienced non-unions within the first 6 postoperative months. .
- Hip recovery scores significantly improved from baseline to the 6-month follow-up in both groups (MSP: p<0.001; DHS: p=0.03). There were no significant between-group differences in hip recovery (MSP: 49.7%; DHS: 51.0%; p>0.05).
- Median surgical time was significantly lower in the DHS group (50 minutes) compared to the MSP group (56 minutes) (p=0.01).
- Tip-apex distance, as measured with radiographic images, was significantly greater in the MSP group at 6 months (p=0.02). There was no significant difference in neck-shaft angle between groups (p>0.05).
- There was no significant difference between groups in length of hospital stay, haemoglobin drop, number of transfusions, transfusion units, leg-length discrepancy, loss in range of motion, and the incidence of complications (p>0.05).
- At 6 months, 18 patients in the DHS group and 11 patients in the MSP group had died, a non-significant difference (p>0.05).
Was sollte ich mir besonders merken?
At 6 months, in patients with unstable intertrochanteric fractures, the use of a sliding hip screw with a Medoff sliding side plate resulted in a similar re-operation rate, hip function recovery scores, length of hospital stay, haemoglobin drop, number of transfusions, transfusion units, leg-length discrepancy, loss in range of motion, and the incidence of complications. Surgical time was significantly greater with the Medoff sliding side.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Results from this study suggest that, in patients with unstable intertrochanteric fractures, the use of a sliding hip screw with a Medoff sliding side plate provides similar short-term outcome to that of a sliding hip screw with a fixed side plate. Additional higher-powered studies, using surgeons of known similar experience, are required to verify these findings.
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