Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management: The INSITE Randomized Clinical Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2023;11(11):15 JAMA Netw Open. 2023 01-Apr.Exclusive Author Interview
What this means for my practice?
This international, multicentered RCT is the first of its kind. The results of this study suggest that sliding hip screws provide comparable clinical outcomes to intramedullary nailing for the treatment of trochanteric hip fractures, and could offer a lower cost alternative for specific patient populations. However, mobility and function in the first 3-6 months post-operation did appear to be in favour of intramedullary nailing, suggesting some short term efficacy. Future studies comparing different nails to specific sliding hip screws are of interest to identify optimal fixation devices. Moreover, the populations that are better suited to intramedullary nailing should be identified and explored in further trials.
Study Summary
850 patients with trochanteric fractures were randomized to receive surgical fixation using an intramedullary nail (n=423, Gamma3 Stryker) or a sliding hip screw (n=427). The primary outcome of interest was health-related quality of life, measured using the Euro-QoL 5-Dimensions (EQ-5D) scale. Secondary outcomes of interest included the incidence of revision, rate of healing, adverse events, mobility, and hip function. Outcomes were assessed up to 1 year post-operation. The results demonstrated similar quality of life, mobility, function, healing, and safety outcomes between the two groups at 1 year post-operation. Given the lower cost of sliding hip screws, it may offer a viable and effective alternative to intramedullary nailing for this patient population.
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