Intramedullary versus extra medullary fixation for basicervical femoral fractures : which is better?


basicervical femoral fracture ; wedge effect ; intramedullary nailing ; extramedullary device

Published online: Oct 08 2021

Wu Chean Lee, Ping Yen Yeo, Beng Kee Ernest Kwek

From the Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore


The basicervical femoral fracture (BCF) is rare and may be fixed with an intramedullary nail or an extramedullary device. The intramedullary nail is thought to cause an intraoperative wedge effect at the BCF, causing a fracture displacement. This study aims to compare the radiological and clinical outcomes of the use of intramedullary nail and extramedullary device for BCFs.

Patients with BCFs treated with an intramedullary nail or extramedullary device over 5 years were reviewed. The neck shaft angle (NSA) at before and after insertion of the implants were compared. The fracture reduction was also qualitatively reviewed by a fellowship-trained senior trauma surgeon. The Modified Barthel Index (MBI) and Modified Functional Ambulation Classification (MFAC) at pre- morbid and at 1 year post-operation were compared. Thirty-one extramedullary device and 18 intra- medullary nail fixations were performed. Both groups had similar demographics. The NSA before the insertion of implants were similar (137.2?±5.1? vs. 134.8?±5.6?, p=0.191). After the insertion of the implants, the NSA in the extramedullary device group increased, while the NSA in the intramedullary nail group decreased (138.7?±5.1? vs. 133.6?±5.6?, p=0.003). The quality of reduction were similar in both groups. Both groups experienced similar declines in MBI over 1-year post-operation (-9.3±21.1 vs. -4.1±23.2, p=0.670). The median MFAC was indoor walker in both groups (p=0.328) with similar distribution in the change of MFAC over 1-year post-operation (p=0.863).

In basicervical femoral fractures, intramedullary nail fixation caused a wedge effect, but the short-term clinical outcomes were similar between intra- and extramedullary fixations.