Baylor University Medical Center Proceedings July 2017 - 268

Rate of contralateral hip fracture after dynamic hip screw
vs intramedullary nail for treatment of pertrochanteric hip
fractures
Jonathan D. Hughes, MD, Justin H. Bartley, MD, Kindyle L. Brennan, PhD, PT, Yolanda Munoz Maldonado, PhD, Michael L.
Brennan, MD, and Christopher D. Chaput, MD

A retrospective, comparative study was performed reviewing the electronic
medical records and digital radiographs of patients who underwent treatment for intertrochanteric and pertrochanteric hip fractures with either a hip
screw and side plate (HSSP) or intramedullary nail. A total of 430 patients
were treated with HSSP, and 725 were managed with a cephalomedullary
nail (CMN). Of these, 103 sustained a contralateral hip fracture. Fixation
technique was not associated with a significant difference in the rate of
contralateral fracture. Among the patients with a contralateral fracture,
the median time to contralateral fracture was 119.28 months following
HSSP and 81.97 months following CMN. Bisphosphonate use was found
to be a significant predictor of contralateral fracture for all patients, but
when matching using propensity scores, its use was found to be insignificant. In conclusion, there was no difference in the rate of subsequent
contralateral hip fracture when comparing HSSP with CMN. Additionally,
the time to second surgery between the two treatment modalities was
found to be statistically insignificant. It is unclear if bisphosphonate use
increased the odds of having a contralateral fracture, regardless of the
surgical intervention. The difference in the bisphosphonate effect using propensity score matching suggests that the results may be due to
confounding variables and bias.

pidemiologic studies have demonstrated that over
1.6 million US adults sustain a hip fracture yearly, and
that number is expected to increase over the next 5 years
(1). Nearly 14% of Americans die within 6 months of
the initial fracture, while 24% die within 12 months (2-4).
Additionally, 2% to 12% of patients with a hip fracture sustain
a contralateral fracture (5-12). Souder et al (12) indicated an
increased risk of contralateral hip fracture after initial treatment
for a femoral neck fracture with closed reduction and percutaneous pinning, as compared with arthroplasty. Zlowodzki et
al (13) demonstrated that cannulated hip screw constructs for
femoral neck fractures are more prone to shortening, which may
decrease tension on abductors and increase the risk for falls and
subsequent hip fractures. Because the type of surgical treatment
aﬀects the rate of subsequent fractures following femoral neck
fracture, it is reasonable to believe that it would also aﬀect the
rate of contralateral fractures following intertrochanteric and
pertrochanteric (IT/PT) fractures, which are generally treated
with either hip screw and side plate constructs (HSSP) or cepha268

lomedullary nails (CMN). The advantages, disadvantages, and
outcomes following HSSP compared with CMN for IT/PT
fractures have been the subject of multiple studies; however,
to our knowledge, no study has compared HSSP with CMN
in regards to rate of subsequent contralateral hip fracture. This
study aimed to determine whether the type of surgical ﬁxation
(HSSP vs CMN) for initial proximal femoral fractures (excluding neck) inﬂuenced the rate of contralateral hip fracture and
then assessed whether bisphosphonate use, diabetes mellitus,
and smoking aﬀected the rate of contralateral proximal femur
fractures for each treatment modality.
METHODS
This study was a retrospective, comparative chart review
of two cohorts of patients within a single health care system
(Level 3 evidence). This study was approved by our hospital's
institutional review board prior to initiation. All patients who
underwent treatment of an IT/PT proximal femur fracture
(AO-Müller/Orthopaedic Trauma Association [AO/OTA] classiﬁcation of A1, A2, or A3) with an HSSP or CMN between
January 1, 2001, and March 23, 2013, within our single level
1 trauma health care system were identiﬁed. Patients who had
malignant disease, sustained any fracture other than an IT/PT
hip fracture of a native hip, were treated with any procedure
other than HSSP or CMN, or sustained the fracture as a result of
high-energy trauma were excluded from this study. High-energy
trauma was deﬁned as an injury resulting from any mechanism
other than a fall from standing or seated height. In addition, we
excluded patients with sequential bilateral hip fractures whose
ﬁrst fracture was not managed at our facility. We were the treating facility of all hip fractures included in this retrospective
review. In total, 1157 medical records met inclusion criteria
and were reviewed.
All patients were managed by orthopedic senior staﬀ surgeons. The orthopedic implants utilized were the Stryker Omega
Dynamic Hip Screw (West Chester, PA) and the Stryker Gamma
Intramedullary Locking Nail (Kalamazoo, MI). Fracture pattern
From the Department of Orthopedic Surgery, Scott & White Medical Center,
Temple, Texas.
Corresponding author: Jonathan D. Hughes, MD, Scott & White Medical Center,
2401 S. 31st Street, Temple, TX 76508 (e-mail: Jonathan.Hughes@BSWHealth.org).
Proc (Bayl Univ Med Cent) 2017;30(3):268-272

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017