Cadera y pelvis

Intramedullary Hip Screw Versus Standard Compression Hip Screw: Early Postoperative Rehabilitation Comparisons

Bruce H. Ziran, MD; Dan S. Heckman, MD; Carlos M. Olarte, MD; Kent Chou, MD; Jennifer Baranick, OTR/L ORTHOPEDICS 2009; 32:83

Studies comparing the intramedullary hip screw and the compression hip screw for fixation of intertrochanteric hip fractures have shown little difference in final functional outcome. However, the characteristics of the rehabilitation process for these implants have not been analyzed. This study used the Functional Independence Measure (FIM Instrument; Uniform Data System for Medical Rehabilitation, Amherst, New York) to better characterize the subtle differences of the perioperative, clinical, and rehabilitative treatment of intertrochanteric fractures using the intramedullary hip screw or compression hip screw. Ninety-four patients with isolated intertrochanteric fractures were treated with either an intramedullary hip screw or compression hip screw at our institution. To reduce technical bias, only experienced surgeons were used and patient allocation was surgeon based (eg, surgeons consistently used the same preferred implant). We evaluated the following FIM categories: bed mobility, bed transfer, gait independence, and distance ambulated. Length of stay and level of discharge disposition were also evaluated. The intramedullary hip screw group performed better with bed transfers (P<.05), demonstrated better ambulatory ability at discharge (P<.06), and had an increased gait distance at discharge (P<.07). Skin-to-skin operative time and estimated blood loss was significantly less for the intramedullary hip screw group. Length of hospital stay and discharge disposition failed to reach statistical significance. Our study found that when using the FIM scores, some differences were noted in the acute rehabilitation characteristics in patients between the intramedullary hip screw and the compression hip screw. These findings may have medical and social importance as well as significant economic implications. Further study with a larger sample size and more stringent study design are recommended.

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