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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 7/2013

01-07-2013 | Trauma Surgery

Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis

Authors: Young-Kyun Lee, Chin Youb Chung, Moon Seok Park, Kyoung Min Lee, Kyung-Hoi Koo

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2013

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Abstract

Background

The best options of internal fixation for unstable intertrochanteric femoral fractures in elderly osteoporotic patients remain controversial. We determined whether intramedullary nail or extramedullary plate provides better treatment for unstable intertrochanteric fractures using a decision analysis tool that considers quality of life.

Methods

A decision analysis model was constructed containing final outcome score and the probability of mortality within 1 year, infection, and mechanical complications. Final outcome was defined as health-related quality of life and was used as a utility in the decision tree. Probabilities were obtained by literature review, and health-related quality of life was evaluated by asking 30 orthopedic experts to complete a questionnaire. A roll back tool was used to determine the best surgical option, and sensitivity analysis was performed to compensate for decision model uncertainty.

Results

The decision model favored intramedullary nailing in terms of quality of life. In one-way sensitivity analysis, intramedullary nailing was more beneficial than the extramedullary plating, when probability of mechanical complication after intramedullary nailing was below 0.258.

Conclusions

In terms of quality of life, the decision analysis model showed that intramedullary nailing was more beneficial for patients with an unstable intertrochanteric fracture.
Appendix
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Metadata
Title
Intramedullary nail versus extramedullary plate fixation for unstable intertrochanteric fractures: decision analysis
Authors
Young-Kyun Lee
Chin Youb Chung
Moon Seok Park
Kyoung Min Lee
Kyung-Hoi Koo
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 7/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1764-z

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