Koersveld, Lennart van (2024) Comparable Outcomes for Intramedullary Nail and Dynamic Hip Screw in Trochanteric Fracture Treatment: A Nationwide Population Study. thesis, Medicine.
Full text available on request.Abstract
Introduction The optimal treatment for trochanteric femoral fractures remains unclear, with varying recommendations from international guidelines and literature regarding the choice between an intramedullary nail (IMN) and a dynamic hip screw (DHS). This study compares the outcomes of these treatments in the Netherlands. Methods A retrospective cohort study was conducted using data from patients (≥60 years) with trochanteric femoral fractures classified as AO/OTA A1, A2, and A3 from the Dutch Hip Fracture Audit (2018–2023). Treatments with IMN and DHS were compared in terms of mortality, reoperations, complications, and functional recovery. A subanalysis was performed based on stable fractures (AO/OTA A1) versus unstable fractures (AO/OTA A2 + A3). Cox regression analyses were conducted to calculate adjusted hazard ratios (HR) for mortality and reoperations, adjusted for variables such as age and sex. Results The results showed that one-year mortality was not significantly lower with DHS (HR 0.95; 95% CI 0.84–1.04; p=0.3) in both the overall population and subgroups. Reoperations occurred more frequently with DHS in the overall population, though the difference was not statistically significant (HR 1.11; 95% CI 0.81–1.53; p=0.5). Complications were less frequently recorded with DHS in the overall population (23.4% vs. 34.0%; p<0.001). Total functional recovery was only more favorable with DHS in stable fractures (52.4% vs. 49.8%; p<0.001). Conclusion This study demonstrates no superiority of either treatment in terms of mortality and reoperations. However, DHS results in fewer complications during hospital admission in the overall population, and better functional recovery in stable fractures. Based on these results, there is no reason to change the current Dutch guideline, though emphasis should be placed on ensuring adherence to these guidelines.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Bremen, Drs. Hanne-Eva van and Flikweer, Dr. Elvira |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Oct 2025 12:54 |
| Last Modified: | 24 Oct 2025 12:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3840 |
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