Early Outcome of Extracapsular Hip Fracture Treatment with Intramedullary Nail and Side Plate
NE Duru, O Ede, UE Adetula, I Anichi, N Duru, B Okonedo, R Ogba, B OkwaraBackground:
Extracapsular hip fractures (intertrochanteric and subtrochanteric) account for 30–50% of hip fractures in Nigerian clinical settings and can be associated with serious complications that result in loss of independence if not properly managed. [1] Conservative treatment is associated with poor outcomes; hence, surgical fixation methods are the standard of care. Extramedullary fixation using a side plate allows compression at the fracture site, which promotes healing, while intramedullary nailing provides a load-sharing mechanism that enhances stability. [2,3] The potential advantages of combining intramedullary nailing with side plate augmentation can integrate the load-sharing capacity of intramedullary nails with the additional lateral support provided by side plates, thereby reducing the risk of implant failure and improving functional outcomes. There is, however, limited consensus on the indications for this approach as well as its effect on early clinical and functional outcomes, prompting our evaluation of this technique.
Aim:
The aim of this research is to study the early outcomes of extracapsular hip fractures treated in our hospital using the Surgical Implant Generation Network (SIGN) intramedullary nail and side plates.
Methods:
A retrospective review was conducted over 48 months (between January 2019 and December 2022) of all extracapsular hip fractures treated with SIGN intramedullary nail and side plates called SIGN High Versatility plates or SIGN Fracture plates at the National Orthopaedic Hospital, Enugu, Nigeria (a regional trauma center). Demographics of patients were recorded, as well as implant-related variables like nail length, width, and number of locking screws, their influence on outcomes like time to fracture healing, the squat and smile score, and complications were studied. Data were analyzed using means, Chi-square test, Fisher’s exact test, and one-way analysis of variance test, as appropriate. Data analysis was performed using IBM SPSS version 27. The statistical significance was set at
Results:
There were 30 cases with a male: female ratio of 2:1. The mean age at presentation was 56.15 ± 20.24 years. Nineteen fractures (63.3%) were unstable, while the rest were stable, with the mean time to fracture healing being 20.13 ± 4.98 weeks. The time to radiological healing (in weeks) was the clinical outcome studied, while the squat and smile score was the functional outcome measured. The intertrochanteric fractures had a poorer functional outcome with a mean squat and smile score of 0.55 compared to subtrochanteric fractures with an outcome score of 1.32.
Conclusion:
Unstable hip fractures had a longer time to fracture healing than stable fractures, while subtrochanteric fractures had a better squat and smile outcome score in extracapsular hip fractures treated with SIGN intramedullary nail and side plate than intertrochanteric fractures.