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- Talk
- 17/08/2022
- UK
IM Nail or the Sliding Hip Screw....What is the Evidence?
Description
The presentation begins with Jan-Erik Gjertsen introducing himself and the context of his work with the Norwegian Hip Fracture Register. He touches on the geographical location of Bergen, Norway, to provide some setting for the audience. He raises the ongoing debate regarding the choice between using intramedullary nails or sliding hip screws for hip fractures, highlighting the arguments on both sides. Gjertsen cites a lack of large-scale randomized controlled trials, noting that existing studies tend to have limited scope and outdated designs.
The speaker presents data from their register, indicating a rising trend in the use of intramedullary nails, especially for A2 and A3 types of fractures, while questioning whether a one-size-fits-all approach is appropriate for treatment. He stresses the importance of considering fracture stability and distinguishing between fracture types when deciding on the surgical approach. His analysis of the INTERTAN study reveals no significant differences in outcomes between the two treatments yet notes discrepancies in initial pain management and complication rates.
Further, Gjertsen focuses on A1 and A2 fractures, discussing evidence from multiple studies indicating that sliding hip screws remain a preferred option for A1 fractures due to lower reoperation rates. Different perspectives on the treatment of A2 and A3 fractures emerge with mixed findings across various studies. He concludes that while sliding hip screws are advantageous for stable fractures, the choice for unstable fractures remains ambiguous.
In the conclusion, Gjertsen summarizes that for stable fractures, sliding hip screws are favored, while intramedullary nails are recommended for A3 fractures. However, for A2 fractures, there is no clear consensus, leaving room for further research to guide treatment decisions. He emphasizes that while trends indicate a rise in the use of nails, particularly in Norway, solid evidence backing this trend is still lacking. The presentation wraps up with a Q&A session, addressing increases in nail usage and mortality concerns raised by other studies.