PAGE PROOFS Functional Outcome and Complications Using the Intramedullary Hip Screw for Intertrochanteric Fractures Andreas F. Mavrogenis, MD, 1 Vassilios Nikolaou, MD, 2 Nikolaos Efstathopoulos, MD, 2 Demetrios S. Korres, MD, 3 and Spyros G. Pneumaticos, MD, 3 We prospectively studied 110 consecutive patients with intertrochanteric hip fractures treated with the 130 ° angle, 10-mm short IMHS intramedullary hip screw (IMHS, Smith & Nephew, Richards, Memphis, TN). Surgery was performed within 36 hours from admission; all patients were mobilized immediately postoperatively. Fracture union, pre- and post-operative mobility status and complications were evaluated. Eighty patients were included in the postoperative evaluation for a mean followup of 14 (range, 9 to 25) months. Mortality was 19%. Union occurred in 79 fractures within 6 months from surgery; there was one case of screw cut-out and one case of deep venous thrombosis. Periprosthetic femoral shaft fractures were not observed. At the latest examination, the mean mobility score decreased from 8.4 š 1.6 to 7.1 š 2.1 (p D 0.0001); 26 patients (32%) fully achieved the preoperative mobility score and 54 patients (68%) achieved more than 90% of the preoperative mobility score. The IMHS intramedullary hip screw represents a reliable method for the treatment of patients with intertrochanteric hip fractures, and provides for early mobilization and rehabilitation of the patients with acceptable complications. ( Journal of Surgical Orthopaedic Advances 20(3):0 – 0, 2011) Key words: Intertrochanteric Hip Fracture, Intramedullary Hip Screw, Postoperative Mobility Introduction Hip fractures remain a significant source of morbidity and mortality in the elderly, with an increasing inci- dence as population ages; 90% of hip fractures occur in patients older than 65 years and about 75% of these occur in women (1). Approximately half of these fractures involve the intertrochanteric region. Despite this frequent occurrence, the method of optimum stabilization of these fractures and subsequent mobilization of the patients still remains a matter of debate. The sliding hip screw with angular plate provided satis- factory results in the treatment of intertrochanteric frac- tures over the past decades (2). Nonetheless, these internal fixation systems have been associated with a failure rate of up to 23% (3). Intramedullary sliding hip screw devices were introduced in the late 1980s (4). Their main advantage was adequate stability with minimal surgical From the 1 First, 2 Second, and 3 Third Departments of Orthopaedics, Athens University Medical School, Athens Greece. Address corre- spondence to: Andreas F. Mavrogenis, MD, First Department of Orthopaedics, Athens University Medical School, 41 Ventouri Street, 15562 Holargos, Athens, Greece, e-mail: andreasfmavrogenis@yahoo.gr. Received for publication April 5, 2009; accepted for publication June 7, 2010. For information on prices and availability of reprints call 410-494- 4994 X232. 1548-825X/11/2003-0000$22.00/0ž AQ1 exposure. However, the first generation intramedullary hip screws did not receive wide acceptance due to the high incidence of femoral shaft fractures at the nail tip (5). Subsequently, the intramedullary hip screws were modi- fied to improve clinical results, minimize complications, and provide for improved and earlier mobilization of the patients (6, 7). The purpose of this prospective study was to evaluate the perioperative complications and postoperative mobi- lization of patients with intertrochanteric hip fractures treated by internal fixation using an intramedullary hip screw. Patients and Methods From June 2003 to December 2004, one hundred and ten consecutive patients were treated at the authors’ institution for an intertrochanteric hip fracture using the intramedullary hip screw (IMHS, Smith & Nephew, Richards, Memphis, TN). There were 75 women and 35 men; the mean age of the patients was 78 (range, 67 to 95) years. All patients were ambulatory prior to their fracture and did not have any severe underlying medical conditions (grade V American Society of Anesthesiologists [ASA] score) (Table 1) (10). In two patients, the fracture resulted from high energy trauma (motor vehicle accident); the rest of the fractures resulted from a low energy fall Copyright  2011 by the Southern Orthopaedic Association VOLUME 20, NUMBER 3, FALL 2011 1