In a randomised trial involving 598 patients
with 600 trochanteric fractures of the hip, the fractures were treated with
either a sliding hip screw (n = 300) or a Targon PF intramedullary
nail (n = 300). The mean age of the patients was 82 years (26 to
104). All surviving patients were reviewed at one year with functional
outcome assessed by a research nurse blinded to the treatment used.
The intramedullary nail was found to have a slightly increased mean
operative time (46 minutes (sd 12.3) versus 49
minutes (sd 12.7), p <
0.001) and an increased mean radiological
screening time (0.3 minutes (sd 0.2) versus 0.5
minutes (sd 0.3), p <
0.001). Operative difficulties
were more common with the intramedullary nail. There was no statistically
significant difference between implants for wound healing complications
(p = 1), or need for post-operative blood transfusion (p = 1), and
medical complications were similarly distributed in both groups.
There was a tendency to fewer revisions of fixation or conversion
to an arthroplasty in the nail group, although the difference was
not statistically significant (nine versus three
cases, p = 0.14). The extent of shortening, loss of hip flexion,
mortality and degree of residual pain were similar in both groups.
The recovery of mobility was superior for those treated with the
intramedullary nails (p = 0.01 at one year from injury).
In summary, both implants produced comparable results but there
was a tendency to better return of mobility for those treated with
the intramedullary nail.