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PURPOSE: The purpose of this study was to compare femoral head placement, rates of reoperation and cephalic implant cut-out of a screw versus a blade for patients over age 60 with low energy trochanteric fractures (AO/OTA 31-A1, A2, and A3) treated either with sliding hip screw or cephalomedullary nail. METHODS: After surgeon selection of either hip screw or nail, hip screw patients were randomised to either a DHS (dynamic hip system screw) or DHS blade (dynamic hip system blade), while nail patients were randomised to either a Gamma3 Trochanteric Nail or a PFNA (proximal femoral nail antirotation). This resulted in a screw group (DHS and Gamma nail), and a blade group (DHS blade and PFNA). Outcome measures included tip-apex distance and zone location of the cephalic implant, as well as reoperation and implant cut-out within the first postoperative year. RESULTS: A total of 335 patients were randomised, 172 to a screw and 163 to a blade. There was no significant difference concerning mean tip-apex distance, percentage of patients with a tip-apex distance >25 mm, and patients with a centre-centre position of the cephalic implant. There were 137 patients in the screw group and 132 in the blade group available for follow-up. They did not differ regarding rates of reoperation or cut-out (screw group = 2.9%; blade group = 1.5%). CONCLUSIONS: Both a screw and a blade performed equally well in terms of implant placement in the femoral head and outcome.

Original publication




Journal article


Int orthop

Publication Date





1855 - 1861


Aged, Aged, 80 and over, Bone Nails, Bone Screws, Female, Fracture Fixation, Internal, Hip Fractures, Hip Prosthesis, Humans, Male, Middle Aged, Osteoporotic Fractures, Prospective Studies, Prosthesis Design, Prosthesis Failure, Radiography, Recovery of Function