Comparison of Short-term Complication Rates Between Cephalomedullary Hip Screw Devices and Sliding Hip Screws: An Analysis of the National Surgical Quality Improvement Program Database.

BACKGROUND

The literature pertaining to the management of intertrochanteric hip fractures using cephalomedullary hip screws (CMHSs) and sliding hip screws (SHSs) has shown varying results. CMHS use has increased over time without validation of its superiority in the literature.

METHODS

We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Program database. Patients who had sustained a peritrochanteric hip fracture were identified. Short-term (<30 day) complications were identified with adjustments made for preoperative comorbidities. We also examined the relative percentages of CMHS and SHS surgeries over time.

RESULTS

A total of 14,415 subjects met the inclusion criteria. Patients undergoing SHS surgery were generally healthier, having a lower American College of Surgeon class, preoperative bleeding, hypertension, pulmonary risk factors, congestive heart failure, and higher preoperative hematocrit. After adjusting for demographics and comorbidities, we noted a higher rate of 30-day mortality (odds ratio [OR] = 1.19; P = 0.024), bleeding (OR = 1.10; P = 0.007), pulmonary complications (OR = 1.19; P = 0.049), and clotting events (OR = 1.35; P = 0.035) in the CMHS group. We observed a higher rate of urinary tract infection (OR = 0.81; P = 0.023) and length of stay (1.0 days; P < 0.0001) in the SHS group. The overall percentage of SHS cases was 33% and trended lower over time.

CONCLUSIONS

Although differences in complication subtypes and the overall complication rate were found, further multicenter, randomized controlled trials would be helpful in elucidating differences between the treatment groups. The popularity of the CMHS continues to increase over time.