• Riccardo Maria Lanzetti, Auro Caraffa, Domenico Lupariello, Paolo Ceccarini, Giulio Gambaracci, Luigi Meccariello, Francesco Manfreda, Daniele Maiettini, Cristina Ibáñez Vicente, Michele Scialpi, Olga Bisaccia, Giuseppe Rinonapoli, and Michele Bisaccia.
• U.O.C. Orthopedics and Traumatology Department, SM Misericordia Hospital, University of Perugia, Perugia, Italy. riccarolanzetti@gmail.com.
• Eur J Orthop Surg Tr. 2018 May 1; 28 (4): 649-658.

BackgroundIntertrochanteric fractures are of great interest worldwide and are the most frequently operated fractures. Intramedullary nailing is commonly used in the treatment of intertrochanteric fractures. The purpose of this study is to assess the necessity of using the distal blocking screw in 31-A1 and 31-A2 fractures, classified according to the Orthopaedic Trauma Association classification system (AO/OTA).MethodsThis is a prospective study of 143 consecutive patients (mean age 85.01 years, mean final follow-up 14.1 months) surgically treated with the same intramedullary nail. In 75 cases, the distal locking screw was not used. Parameters evaluated during follow-up were: blood loss, transfusion requirements, surgery duration, and fluoroscopy time. Harris Hip Score and Barthel Activity Daily Living were used for the clinical evaluation. Radiographic Union Score For Hip (RUSH score) and Tip apex distance (TAD) were measured for radiologic evaluation.ResultsThe group treated without locking screw showed significantly shorter surgical duration time (31.9 vs. 47.2 min), a decrease in blood loss (variation Hb - 1.06 vs. - 1.97), and reduced X-rays exposure time (25.4 vs. 31.6 s). No significant differences were observed in the postoperative period and in the radiographic and clinical scores.ConclusionThis study demonstrates that in intertrochanteric 31-A1 and 31-A2 stable fractures, the absence of distal locking screw does not compromise bone healing and prevents several clinical complications.

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