A RETROSPECTIVE STUDY OF THE MANAGEMENT OF SUBTROCHANTERIC FEMORAL FRACTURES WITH THE RUSSELL-TAYLOR RECONSTRUCTION NAIL VERSUS THE DYNAMIC CONDYLAR SCREW

Abstract

Many studies exist that assess intramedullary and extra-medullary fixation of these fractures, but few exist that compare the two. We performed a retrospective cohort study to compare the above implants in the management of subtrochanteric femoral fractures. 100 fractures in 95 patients were studied, with 47 in the recon nail group and 53 in the DCS group, with 33 male and 62 females, average age 68 years (16–98 years). Data was obtained by review of case notes and x-rays of all cases. The following information was obtained :- age, sex, energy/mechanism of injury, fracture classification (AO & Russell-Taylor, single observer), grade of surgeon, duration of surgery, ASA grading, co-morbidity (using Covinsky score), pre-operative mobility, postoperative mobility (using D’Aubigne & Postel score), mortality, intra-operative complications, post-operative complications, revision surgery/implant failure, follow-up and radiological assessment of reduction/implant position(single observer). Statistical analysis of the data was performed using chi-squared, Fisher’s, Mann-Whitney U and unpaired t-tests. Results showed no significant differences in co-morbidity, complications, mortality, duration of surgery, hospital stay, sex, surgical grade or pre-operative mobility. There were significant differences in age, fracture classification, radiological assessment of reduction/implant position, mechanism of injury and post-operative mobility. Overall 28-day mortality was 8%, post-op complications were seen in 54% and 19 cases required further surgery (detailed breakdown to be presented). Certain areas of bias were identified, in that the DCS had a higher number of complex fracture patterns, thus affecting post-op mobility, whereas the recon nail group had a higher proportion of pathological fractues.