Stabilisation of unstable pertrochanteric hip fractures: A feasibility randomised control trial comparing Endovis proximal femoral nail vs Dynamic Hip Screw

There is still no consensus on the best fixation device for unstable pertrochanteric (i.e. AO/OTA 31A2) fractures. Interestingly, a third of patients with hip fractures have a degree of cognitive impairment and are usually excluded from relevant randomised trials.
The aim of this study was to assess the feasibility of performing a randomised control trial including patients with and without cognitive impairment and to compare intramedullary nail and Dynamic Hip Screw (DHS) for the fixation of unstable pertrochanteric fractures.
The abbreviated mental Test Score (AMTS) was used to screen for dementia. The Timed Up and Go (TUG) test was used as the primary outcome measure. Peri-operative parameters, patient-reported outcomes and radiographic parameters were used as secondary clinical outcomes. Patients were followed-up at 2, 4 and 12 weeks.
Although it was feasible to recruit 60 patients, retention rates were lower than expected, especially among patients with dementia. Moreover, the TUG test proved was not a suitable tool to be used as a functional outcome measure; high proportion of patients were not able to perform it even at 12 weeks.
There was preliminary evidence of treatment effect in pain assessment at 2 weeks and radiographic outcomes at all time points in favour of the nail group.
In conclusion, it is feasible to perform an RCT including patients with and without dementia, but high levels of attrition are to be expected. The Timed Up and Go test was not a suitable tool to be used in this population. Fixation with a nail appeared to be advantageous to fixation with a DHS in terms of early pain levels and radiographic outcomes.