Moderate evidence supports the use of either a sliding hip screw or a cephalomedullary device in patients with stable intertrochanteric fractures.

Management of Hip Fractures in the Elderly
Endorsed by: OTA, AGS, AAPM&R, ASBMR, USBJI, The Hip Society, AACE, ORA
Moderate Evidence MODERATE EVIDENCE
Rationale
One high quality (Ahrengart et al94) and two moderate strength (Utrilla et al 95, Varela et al96) studies compared the use of an extramedullary sliding hip screw device with a cephalomedullary device for stable intertrochanteric fractures.  The high strength study compared a cephalomedullary device and sliding hip screw in both stable and unstable intertrochanteric fractures (Ahrengart et al 94).  Subgroup evaluation of the stable fractures favored the use of a sliding hip screw with respect to operative time and blood loss. One moderate strength study (Utrilla et al 95) found no difference in walking ability with either a sliding hip screw or cephalomedullary nail for the stable intertrochanteric fractures. The other moderate strength study (Varela et al96) found no difference in functional outcome, hospital stay, fracture collapse, or mortality between a cephalomedullary nail and an extramedullary sliding hip screw and plate device that offers two points of fixation into the femoral head. 
 
Risks and Harms of Implementing this Recommendation

There are no known harms associated with implementing this recommendation.
 
Future Research
Randomized, prospective trials comparing modern cephalomedullary nails with extramedullary devices in a large cohort of patients with only stable intertrochanteric fractures (OTA 31.A1) should specifically assess functional outcomes, radiographic parameters, complications, and cost. These studies should control for patient demographics as well as quality of fracture reduction and placement of fixation (tip-to-apex distance). The potential difficulty with conversion to total hip arthroplasty for failed fracture treatment also should be considered when comparing fixation methods.
 
  1. (94) Ahrengart L, Tornkvist H, Fornander P et al. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res 2002;(401):209-222.
  2. (95) Utrilla AL, Reig JS, Munoz FM, Tufanisco CB. Trochanteric gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the gamma nail. J Orthop Trauma 2005;19(4):229-233.
  3. (96) Varela-Egocheaga JR, Iglesias-Colao R, Suarez-Suarez MA, Fernandez-Villan M, Gonzalez-Sastre V, Murcia-Mazon A. Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Arch Orthop Trauma Surg 2009;129(10):1401-1407.