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Nail Fixation Rate Soaring for Hip Fractures

Review authors question dramatic switchover from traditional plate fixation

THURSDAY, April 17 (HealthDay News) -- Since 1999, there has been a dramatic increase in the rate of young surgeons performing intramedullary nail fixation for intertrochanteric hip fractures despite a lack of evidence demonstrating its superiority over plate fixation and other evidence suggesting it may be associated with more complications, according to a review article published in the April issue of the Journal of Bone & Joint Surgery.

Jeffrey O. Anglen, M.D., of Indiana University in Indianapolis, and James N. Weinstein, of the Dartmouth Hitchcock Medical Center in Lebanon, N.H., on Behalf of the American Board of Orthopaedic Surgery Research Committee, searched the American Board of Orthopaedic Surgery database for all intertrochanteric fractures (International Classification of Diseases, Ninth Revision, code 820.20 or 820.21) between 1999 and 2006.

The researchers found that the intramedullary nail fixation rate increased from 3 percent in 1999 to 67 percent in 2006, and that surgeons in the South, Southeast and Southwest were quickest to embrace the new technology. Compared to patients managed with plate fixation, they also found that patients managed with intramedullary nailing had slightly more pain, deformity and procedure-rated complications, but the same level of function and satisfaction.

"This has resulted in higher implant costs and surgeon fees, with no improvement in patient outcomes," the authors conclude. "We believe that the difference in relative value units between the two surgical technique alternatives for the same condition should be carefully scrutinized and that any differences should be based solely on measured differences in work."

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