JOT - 2026-09-01 - Journal Article; Comparative Study
Blade Versus Screw Complication Risk for Intertrochanteric Fracture Fixation.
Richey Levine A, Cross JL, Klug T, Salameh M, Riedel M, Leslie M
Topics
Key Takeaway
Blade versus screw choice in cephalomedullary nailing for intertrochanteric fractures showed no difference in complications (5.7% vs. 5.4%) or reoperation (5.2% vs. 3.7%), while malreduction and patient factors—not implant type—drove adverse outcomes.
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Summary
This single Level I trauma center retrospective cohort compared bony complications and reoperation rates between cephalomedullary nail blade and screw constructs for OTA/AO 31A intertrochanteric fractures from 2014–2023. No significant difference was found in overall complications (blade 5.7% vs. screw 5.4%, P=0.836) or reoperations (5.2% vs. 3.7%, P=0.232), including in subgroup analysis by fracture stability. Logistic regression identified reduction quality (tip-apex distance, neck-shaft angle, multiplanar adequacy), BMI, ASA status, smoking, and fracture stability as significant predictors of complications; implant type was not predictive in any model.
Key Limitation
Retrospective design at a single center precludes controlling for surgeon-level variability in reduction technique and implant selection criteria, which are likely confounded with the outcomes attributed to reduction quality.
Original Abstract
OBJECTIVE
To determine whether the use of a screw or blade for fixation in intertrochanteric fracture intramedullary nailing is associated with bony complications, specifically cut-through, cut-out, malunion, nonunion, proximal hardware backout, and reoperation.
DESIGN
Retrospective cohort study.
SETTING
Single Level I Trauma Center.
PATIENT SELECTION CRITERIA
Patients with intertrochanteric hip fractures (OTA/AO 31A) between 2014 and 2023 who underwent fixation with the same type of cephalomedullary nails (CMN) with either a blade or screw for proximal femur stabilization were identified based on Current Procedural Terminology Codes 27245.
OUTCOMES MEASURES AND COMPARISONS
Bony complications, specifically cut-through, cut-out, malunion, nonunion, proximal hardware backout, and/or reoperation, were compared across blade and screw implants for patients. This comparison was completed for the entire cohort, with patients stratified by fracture stability, and with the application of propensity matching across fracture and demographic characteristics.
RESULTS
In total, 1078 patients were included. The 615 patients treated with CMN blade had a mean age of 83.1 (range 65-106) years and 451 were women. The 463 patients treated with CMN screw had a mean age of 83.3 (range 65-103) years and 354 were women. No statistical significance was found between CMN blade versus screw cohorts for complications (Blade: 5.7% vs. Screw: 5.4%, P = 0.836) or reoperations (Blade: 5.2% vs. Screw: 3.7%, P = 0.232). This held true when patients were stratified based on fracture instability for both complications (Blade: 6.8% vs. Screw: 8.0%, P = 0.574) and reoperations (Blade: 5.5% vs. Screw: 5.1%, P = 0.835). Logistic regression conducted to find risk factors associated with complications or reoperation identified reduction parameters (adequate reduction in all planes, neck shaft angle, and tip-apex distance) and patient characteristics (body mass index, American Society of Anesthesiologists Status, smoking status, and fracture stability) as significant ( P < 0.05). Use of blade or screw did not emerge as predictive in any model.
CONCLUSIONS
Blade versus screw choice for intertrochanteric femur fragility fractures fixed with cephalomedullary nails was not significantly associated with differences in complications or reoperation when stratified by fracture pattern and adjusted by patient propensity matching, whereas malreduction correlated with all and specific complications, as well as the need for reoperation.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.