Risk Stratification of Operatively Treated Intertrochanteric Hip Fractures Reveals Differences in Short-Term Outcomes and Procedure Costs Between Sliding Hip Screw Versus Short Cephalomedullary Nail

Abstract

Objective: This study sought to retrospectively compare short-term outcomes between sliding hip screw (SHS) fixation versus short cephalomedullary nailing (CMN) in a risk-stratified cohort of geriatric intertrochanteric hip fracture patients. Data of 458 patients, aged 55 years and older, who sustained intertrochanteric fractures (OTA 31A1-3) and were treated with either SHS or short CMN from October 2014 to March 2019 were collected. Patient demographics, injury severity, and functional status were used to calculate a score using the Score for Trauma Triage in the Geriatric and Middle-Aged system. Based on the Score for Trauma Triage in the Geriatric and Middle-Aged tool, 229 patients (50%) were placed into a low-risk cohort, whereas 229 patients (50%) were placed into a high-risk cohort. Results: Four hundred eleven patients were treated with CMN and 47 patients were treated with SHS. Procedural time was shorter for low- and high-risk patients treated with CMN versus SHS. Need for transfusion did not differ between implant types in either risk cohort. In the high-risk cohort, incidence of major complications and number of overall inpatient complications were higher in the SHS group. In the low-risk cohort, patients with SHS were discharged home more often and ambulated a greater distance before discharge. Although total costs did not differ between groups, procedural costs were lower in the SHS group for both risk cohorts. Multivariate analyses demonstrated that implant type was a significant predictor of all aforementioned significant bivariate analyses. Conclusion: In low-risk and high-risk patients, those treated with CMN had shorter surgical time but higher procedural costs. A decrease in implant cost may optimize the value of shorter procedural times associated with CMN use, especially for high-risk patients. Our results suggested that high-risk hip fracture patients should be treated with CMN for both stable and unstable fractures and low-risk stable fracture patterns should be treated with SHS.