Comparison of Short vs Long Anti-rotation in Treating Trochanteric Fractures

Abstract

Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation.Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out.Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes) when compared to that of a long PFNA (87 minutes). Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA.Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.

Comparison of a twin interlocking derotation and compression screw cephalomedullary nail (InterTAN) with a single screw derotation cephalomedullary nail (proximal femoral nail antirotation): a systematic review and meta-analysis for intertrochanteric fractures

“…Zhang [ 22 ] and Li [ 31 ] noted that the use of long PFNA nails in patients improved the clinical outcomes compared to short nails especially failure rates and pain. Other authors that have looked at long and short PFNA nails and found no difference in clinical outcomes except for intraoperative outcomes such as operating time and blood loss which favour the smaller nails [ 32 – 34 ]. Although our meta-analysis found significant differences in clinical outcomes between InterTAN and PFNA, we cannot be certain that nail dimension did not contribute to the outcomes.…”

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

“…Five studies included information on the number of patients requiring blood transfusion, however only Boone et al . reported that there was a statistically significant difference in transfusion rates 18 , 25 – 27 , 31 .…”

“…Twelve studies included data on operative times for the surgical procedures. All but one study reporting a significantly longer operating time for long CMDs as compared to short CMDs, with Hong being the only dissenting study 18 , 22 – 31 , 33 .…”

“…Eight studies reported on the estimated blood loss from either procedure, with 7 studies reporting statistically significantly higher mean estimated blood loss in long CMD operations as opposed to short CMDs 20 , 24 – 26 , 30 , 31 , 33 . Five studies included information on the number of patients requiring blood transfusion, however only Boone et al .…”

“…A total of 9 studies included the LOS of patients post-operatively, with 8 of the studies reporting no significant difference in LOS between the two groups 18 , 20 , 22 , 25 – 29 , 31 .…”