Fratture laterali del collo di femore nell'anziano : confronto dei risultati del trattamento con chiodo endomidollare e vite-placca in compressione

Purpose of this study is a randomised trial of the treatment of leteral fractures of femur with intra-medullary nail versus dynamic compression hip screw. After short analysis of epidemiology of falls in elderly, show method of the study: 208 lateral fractures are considered in patients with mail, unless fractures type A3-3 of AO classification treated with dynamic compression hip screw (DHS). At 6 months follow-up had revised 118 patients (57%). Had studied: right position of nail and hip screw, them following shift and shift of fractues, surgical time, blood loss, blood transfusions, wound infections, other general complications (thombosis and embolism, skin lesions, bronco-pneumonia, urinal infections), time of load, walking, go up stairs, use of sticks, joint's range of motion, local pain, come back to usual life or admission to home. Results: surgical time and blood loss was short in nail treatment, blood trasfusions was greater in hip screw. Nail had better reduction of fracture and keep it in the time, unstable fractures was stabilized with distal locking. Don't observed new fractures in both types of treatment. Start of load was more quick in nail (median 2 days, in hip screw median 58 days). At 6 months follow-up, all fractures were recovered. In AO A3-3 type of fractures we preferred dynamic compression hip screw because nail at the entry in trochanter can be difficult and can decompose fracture. Conclusions: nail is certainly the gold standard for the treatment of lateral fractures of the femur; dynamic compression hip screw is useful in comminute and unstable fractures. Nail allow swift start of load and so it reduce sickness-rate because of immobilization in the bed. Nail had permit at all patients a quick functional recovery and so too a normal life return, while dynamic compression screw hip had permit it only 60% of patients