Although intramedullary implants are frequently used to treat stable intertrochanteric (IT) fractures, there was little data to show that they are preferable to extramedullary implants in treating these fractures. For a study, researchers sought to assess intramedullary vs. extramedullary implants’ short-term (30-day) results in patients with closed nondisplaced stable IT fractures.
Between 2016 and 2019, patients with closed nondisplaced stable IT fractures were identified using the American College of Surgeons National Surgical Quality Improvement Program database. The study included patients who received either extramedullary or intramedullary implant fixation. Transfusion, surgical complications (stroke, myocardial infarction, venous thromboembolism, pneumonia, renal failure/insufficiency, surgical site infection, urinary tract infections, and sepsis), weight-bearing on postoperative day 1, discharge destination, place of residence <30 days after the operation, days from operation to discharge, readmission related to the index procedure, any readmission, revision surgery, and mortality were among the postoperative outcomes.
The research included 3,244 patients, with 2,521 (77.7%) undergoing intramedullary nailing (IMN). Surgical complications did not differ statistically between the two intervention groups, according to adjusted multivariable analysis (odds ratio [OR] 1.142; CI, 0.838 to 1.558; P=0.4). Patients who had IMN, on the other hand, had a higher rate of blood transfusions (OR, 1.35, CI, 1.042 to 1.748, P=0.023) and were more likely to be discharged somewhere other than home (OR, 1.372, CI, 1.106 to 1.700, P=0.004), and were more likely to be readmitted (OR, 1.783, CI, 1.157 to 2.75, P=0.009). Patients who received IMN had a shorter postoperative stay (OR 0.982, CI 0.967 to 0.998, P=0.030).
Extramedullary implants were shown to be related with reduced transfusion rates, lower readmission rates, and improved patient disposition in the study. When treating stable IT fractures, investigators advised surgeons to explore extramedullary implants, especially if the patient is anaemic or at high risk of hospital readmission.
Reference:journals.lww.com/jaaos/Abstract/2022/05150/Comparison_of_Extramedullary_and_Intramedullary.10.aspx
