Clinical outcomes following long versus short cephalomedullary devices for fixation of extracapsular hip fractures: a systematic review and meta-analysis

Abstract

Although both long and short cephalomedullary devices (CMDs) are used in the treatment of extracapsular hip fractures, the advantages of either option are subject to debate. This study aims to evaluate the differences in clinical outcomes with long versus short CMDs for extracapsular hip fractures. Studies included must have included subjects with at least 1 year of follow-up and reported on at least one of the following outcomes: rate of reoperation; rate of peri-implant fracture; operating time; blood loss; complication rate; length of hospital stay; 1-year mortality. Only articles written in the English language were included in this study. A search was conducted across the databases of Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL and Scopus for articles published from the inception of the database to 1 November 2020. Included studies were assessed for their risk of bias using the Risk of Bias Tool (RoB2) and the risk-of-bias in non-randomized studies – of interventions (ROBINS-I) tool. A total of 8460 fractures from 16 studies were included in the analysis, with 3690 fixed with short, and 4770 fixed with long CMDs. A meta-analysis of the results revealed that short CMDs offer peri-operative advantages, while long CMDs could offer longer-term advantages. Limitations of this study include a lack of randomized control trials included in the analysis. In conclusion, when planning for the treatment of extracapsular hip fractures, a patient specific approach may be necessary to make a decision according to the individual risk profile of the patient.

Failure of Fixation in Trochanteric Hip Fractures: Does Nail Design Matter?

“…Between January 2000 and March 2023, of 659 articles screened, 22 met the inclusion criteria and formed the basis of this study. 7,16–36…”

“…19,27,31,36 However, the long nails were associated with increased estimated blood loss (EBL) and longer operative time. 17,19,27,31,[34][35][36] Interestingly, one study demonstrated a weighted mean difference of 17.57 minutes in operative time in favor of the short CMN group (P , 0.05) and estimated 60 mL reduced EBL. 17 No difference between the 2 nail groups was reported for mean length of hospitalization, 31,34,36 1 year mortality rate, 17,27,31,34,36 nonmechanical complication rate, 1,27,31,36 and patient-reported outcome measures.…”

“…7, Long Versus Short Nails Two recently published systematic review and metaanalysis studies were identified, which together provided analysis of studies published up to November 2020. 17,35 In addition, 6 other articles were found comparing short versus long nails outcome (2 RCT articles 19,27 and 4 retrospective cohort studies 25,31,34,36 ). Description regarding study design, number of patients, and demographics is presented in Table 1.…”

“…17 No difference between the 2 nail groups was reported for mean length of hospitalization, 31,34,36 1 year mortality rate, 17,27,31,34,36 nonmechanical complication rate, 1,27,31,36 and patient-reported outcome measures. 35,36 Two articles also performed a cost-effective analysis and reported higher costs for the long nail group. 24,31 Helical Blade Versus Screw…”

Periprosthetic Fractures in Long Versus Short Proximal Femoral Nailing for Intertrochanteric Fractures: A 10-Year Single-Centre Cohort Study

“…However, there is conflicting evidence regarding the incidence of periprosthetic fractures with each device. Several studies from the 1990s [ 8 , 9 ] and a recent meta-analysis have shown a higher incidence of periprosthetic fractures in the short PFN cohort [ 10 ]. Other studies have shown a lower reoperation rate with short PFNs [ 11 , 12 ], and no statistically significant differences have been quoted in the rates of periprosthetic fractures in systematic reviews [ 12 ].…”