Sliding Hip Screw and Side Plate for Intertrochanteric Hip Fractures

Background: For stable intertrochanteric hip fractures, treatment commonly involves the use of a sliding hip screw. Intertrochanteric hip fractures are increasingly common as the population ages and lives longer. More than 250,000 hip fractures occur per year in the United States(1). The mortality rate within the first year following operative treatment ranges from 14% to 27.3%(2,3). Early surgical repair within 48 hours of injury is associated with a lower risk of mortality(2,4,5). The goals of surgical treatment are restoration of coronal plane alignment without varus angulation and early patient mobilization. Description: The sliding hip screw procedure can be divided into (1) preoperative planning; (2) patient positioning; (3) C-arm setup; (4) closed reduction of fracture; (5) sterile preparation and draping; (6) lateral hip approach; (7) guide pin insertion; (8) triple-reaming the proximal aspect of the femur; (9) sliding hip screw insertion into the femoral neck and head; (10) side plate insertion, engaging the sliding hip screw, and fixation to the femur; (11) lag compression screw insertion (if appropriate); and (12) final fluoroscopic images and wound closure. Alternatives: Intertrochanteric hip fractures must be surgically treated to avoid morbidity and increased risk of mortality. Nonoperative treatment is occasionally indicated in nonambulatory patients or those with high perioperative risk. If treated surgically, a common alternative implant option includes the intramedullary nail. Finally, for severely comminuted fractures or failed internal fixation, total hip arthroplasty may be necessary. Rationale: Sliding hip screws are as effective as intramedullary nails and often less costly(6). In general, the quality of fracture reduction is more critical than the choice of implant(7). A prospective study found no significant difference in walking ability with either sliding hip screws or intramedullary nails for stable intertrochanteric fractures(8). Expected Outcomes: By 6 months, the majority of fractures will have healed; according to a prospective randomized study, 91% of stable fractures and 85% of unstable fractures had achieved radiographic union by that time(9). Another study showed radiographically healed fractures in all 106 patients treated with sliding hip screws at median follow-up of 13.6 months(8).