Barton (2010) — A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial.

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Ao/ota 31-A2 Fractures of the Proximal Part of the Femur: a Prospective Randomized Trial.

·J Bone Joint Surg Am·2010·229 citations·Trauma

Prospective RCT (n=210) comparing long gamma nail (intramedullary) versus sliding hip screw (extramedullary) for unstable AO/OTA 31-A2 proximal femur fractures, with primary outcome of reoperation within one postoperative year and secondary outcomes of mortality, QoL, mobility, length of stay, and transfusion rate.

Study Snapshot

Design

Single-center RCT

Blinding: Open-label

Setting: Single center, Frenchay Hospital, Bristol, UK

Funding: None

Objective

Whether long gamma nail and sliding hip screw differ in reoperation rate for AO/OTA 31-A2 fractures

Outcome(s)

Reoperation rate within first postoperative year

Subjects

210 patients with AO/OTA 31-A2 proximal femur fractures

100Long gamma nail
110Sliding hip screw, 4-hole 135° plate

Inclusion

AO/OTA 31-A2 proximal femur fracture
Age >18 years

Exclusion

Pathological fracture
Previous proximal femoral fracture
Reverse oblique fracture (AO/OTA 31-A3)

Follow-up

12 months

Statistics

Logistic regressionSurvival analysis (log-rank)Linear regressionMultiple imputation

Key Findings

Reoperation rates were equivalent: 3% (gamma nail) vs. 2% (SHS) — all 5 reoperations were for screw cut-out, with no implant failures or deep infections in either group (p = 0.67)
Tip-apex distance >25 mm was present in 3 of 5 patients requiring reoperation vs. only 7% of those who did not — a statistically significant difference (p = 0.01), underscoring that technique matters more than implant choice
Unadjusted one-year mortality appeared higher with gamma nail (32% vs. 22%, p = 0.045), but this difference was entirely explained by a baseline imbalance in mini-mental scores — after correction, no significant difference existed (p = 0.26)
No difference in EuroQol 5D QALYs (0.37 vs. 0.46, mean difference 0.04), length of stay, transfusion rates, or mobility/residence changes between groups
The sliding hip screw costs approximately £1,000 ($1,500) less per case than the long gamma nail with equivalent outcomes — a direct cost argument against routine intramedullary use

Clinical Relevance

For AO/OTA 31-A2 intertrochanteric fractures, the sliding hip screw delivers equivalent reoperation rates, mortality, and functional outcomes compared to the long gamma nail at lower cost — choose your implant based on fracture pattern (A2 vs. A3), not marketing.

Regardless of implant, keep tip-apex distance under 25 mm: in this series, 60% of cut-outs occurred in patients who exceeded that threshold.

Supplemental

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Ao/ota 31-A2 Fractures of the Proximal Part of the Femur: a Prospective Randomized Trial.

Barton, Chesser, et al.·J Bone Joint Surg Am·2010·229 citations·Trauma

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Ao/ota 31-A2 Fractures of the Proximal Part of the Femur: a Prospective Randomized Trial.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Ao/ota 31-A2 Fractures of the Proximal Part of the Femur: a Prospective Randomized Trial.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Ao/ota 31-A2 Fractures of the Proximal Part of the Femur: a Prospective Randomized Trial.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

A Comparison of the Long Gamma Nail with the Sliding Hip Screw for the Treatment of Ao/ota 31-A2 Fractures of the Proximal Part of the Femur: a Prospective Randomized Trial.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles