• Richard Stern, Anne Lübbeke, Domizio Suva, Hermes Miozzari, and Pierre Hoffmeyer.
• Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland. richard.stern@hcuge.ch
• Int Orthop. 2011 Dec 1;35(12):1855-61.

PurposeThe purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail.MethodsAfter surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year.ResultsA total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25 mm, and patients with a centre-centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%).ConclusionsBoth a screw and a blade performed equally well in terms of implant placement in the femoral head and outcome.

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