Pertrochanteric fractures:: Is there an advantage to an intramedullary nail?: A randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail

Objectives: To compare the results between a sliding compression hip screw and an intramedullary nail in the treatment of pertrochanteric fractures. Design: Prospective computer-generated randomization of 206 patients into two study groups: those treated by sliding compression hip screw (Group 1: n = 106) and those treated by intramedullary nailing (Group 2 n = 100). Setting: University Level I trauma center. Patients: All patients over the age of fifty-five years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA Type 31-A1 and A-2. Intervention: Treatment with a sliding compression hip screw (Dynamic Hip Screw Synthes-Stratec, Oberdorf, Switzerland) or an intrarriedullary nail (Proximal Femoral Nail: SynthesStratec, Oberdorf, Switzerland). Main Outcome Measurements: Intraoperative: operative and fluoroscopy times. the difficulty of the operation, intraoperative complications. and blood loss. Radiologic: fracture healing and failure of fixation. Clinical: pain, social functioning score, and mobility score. Results: The minimum follow-up was one year. We did not find any statistically significant difference, intraoperatively. radiologically, or clinically. between the two groups of patients. Conclusions: There is no advantage to an intramedullary nail versus a sliding compression hip screw for low-energy pertrochanteric fractures AO/OTA 31-A1 and A2, specifically with its increased cost and lack of evidence to show decreased complications or improved patient outcome.