OBJECTIVE: To determine if the use of a screw or blade for fixation in intertrochanteric fracture intramedullary nailing is associated with bony complications, specifically cut-through, cut-out, malunion, nonunion, proximal hardware backout, and reoperation. METHODS: Design:Retrospective cohort study. SETTING: Single Level I Trauma Center. PATIENT SELECTION CRITERIA: Patients with intertrochanteric hip fractures (OTA/AO 31A) between 2014 - 2023 that underwent fixation with the same type of cephalomedullary nails (CMN) with either a blade or screw for proximal femur stabilization were identified based on Current Procedural Terminology Codes (CPT) 27245. OUTCOMES MEASURES AND COMPARISONS: Bony complications, specifically cut-through, cut-out, malunion, nonunion, proximal hardware backout, and/or reoperation was compared across blade and screw implants for patients. This comparison was completed for the entire cohort, with patients stratified by fracture stability, and with the application of propensity matching across fracture and demographic characteristics. RESULTS: 1,078 patients were included. The 615 patients treated with CMN blade, had mean age of 83.1 (range 65-106) years and 451 females. The 463 patients treated with CMN screw had a mean age of 83.3 (range 65-103) years and 354 females. No statistical significance was found between CMN blade versus screw cohorts for complications (Blade: 5.7% vs. Screw: 5.4%, p=0.836) or reoperations (Blade: 5.2% vs. Screw: 3.7%, p=0.232). This held true when patients were stratified based on fracture instability for both complications (Blade: 6.8% vs. Screw: 8.0%, p=0.574) and reoperations (Blade: 5.5% vs. Screw: 5.1%, p=0.835). Logistic regression conducted to find risk factors associated with complications or reoperation identified reduction parameters (adequate reduction in all planes, neck shaft angle and tip-apex distance) and patient characteristics (body mass index, American Society of Anesthesiologists Status, smoking status and fracture stability) as significant (p<0.05). Use of blade or screw did not emerge as predictive in any model. CONCLUSIONS: Blade versus screw choice for intertrochanteric femur fragility fractures fixed with cephalomedullary nails was not significantly associated with differences in complications or reoperation when stratified by fracture pattern and adjusted by patient propensity matching, whereas malreduction correlated with all and specific complications, as well as the need for reoperation. LEVEL OF EVIDENCE: Prognostic Level III.
Levine et al. (Tue,) studied this question.