Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up

Vaughn, Josh; Cohen, Eric; Vopat, Bryan G.; Kane, Patrick M.; Abbood, Emily; Born, Christopher T.

doi:10.1007/s00590-014-1557-2

Cited by 55 publications

(52 citation statements)

References 15 publications

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“…These authors concluded that the rate of secondary fracture may be reduced with a long nail design, but further study is required. In a more recent retrospective study, Vaughn et al 30 found a trend toward more periprosthetic fractures with short nails used to treat AO/OTA 31-A1 and A2 fractures (short nail group, 2 of 60, 3.3%; long nail group, 0 of 196, 0%; P=.054).…”

Section: Discussionmentioning

confidence: 95%

“…Other retrospective studies that compared long and short cephalomedullary nails showed no difference in periprosthetic fractures. 14,19,20,30 In theory, long cephalomedullary nails prevent future periprosthetic fracture by spanning the entire femur and are preferred when the fracture extends to the subtrochanteric region or when protection of the entire femoral shaft is nec-essary, as in severe osteoporosis or known metastatic disease. 15 The current results suggest that a long cephalomedullary nail offers the benefit of protecting the entire femur.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with other retrospective studies comparing long nails with short nails. 14,19,20,30,31 Shorter operative time improves both patient safety and operating room efficiency. For patients with multiple comorbidities, shorter operative time decreases postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

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Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture

Frisch¹,

Nahm²,

Khalil³

et al. 2017

Orthopedics

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This study compared patients who underwent treatment with short or long cephalomedullary nails with integrated cephalocervical screws and linear compression. Patients with AO/OTA 31-A2 or A3 pertrochanteric fractures treated with either short (n=72) or long (n=97) InterTAN (Smith & Nephew, Memphis, Tennessee) cephalomedullary nails were reviewed. Information on perioperative measures (estimated blood loss, surgical time, and fluoroscopy time) and postoperative orthopedic complications (infection, implant failure, screw cutout, and periprosthetic femur fracture) was included. Estimated blood loss (short nail, 161 mL; long nail, 208 mL; P=.002) and surgical time (short nail, 64 minutes; long nail, 83 minutes; P=.001) were lower in the short nail group. There were no differences in fluoroscopy time (short nail, 90 seconds; long nail, 142 seconds; P=.071) or rates of infection (short nail, 1.4%; long nail, 3.1%; P=.637) or overall orthopedic complications (short nail, 11.1%; long nail, 9.3%; P=.798) between the 2 groups. The long nail group had a trend toward more screw cutouts (long nail, 5.2%; short nail, 0.0%; P=.134) but fewer periprosthetic femur fractures (short nail, 8.3%; long nail, 0.0%; P=.013). This study found a similar overall rate of orthopedic complications between short and long nails with integrated cephalocervical screws and linear compression. These results confirm the suspected advantages of short nails, including faster surgery and less blood loss; however, the rate of periprosthetic femur fracture remains high, despite changes to implant design. [Orthopedics. 2017; 40(2):83-88.].

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture

Frisch¹,

Nahm²,

Khalil³

et al. 2017

Orthopedics

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“…We must admit limitations of our study including the possibility of surgeon bias towards the use of either a straight or cephallomedullary nail in certain fracture patterns, which remains hidden in our retrospective study design. Despite the fact that long nails seem to offer no clinical advantage compared to standard nails for the treatment of 31 A3 type fractures except a reduced rate of secondary femur fracture [22, 44, 45], we included only long nails. This is in accordance with the recently published algorithm for the treatment of per-/intertrochanteric fractures of the hip [19].…”

Section: Discussionmentioning

confidence: 99%

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

et al. 2019

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IntroductionThe OTA/AO type 31 A3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Intramedullary fixation using different types of nails is commonly preferred. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary nail treatment in regard to surgical procedure, complications, and clinical outcomes.MethodsFrom one level 1 trauma center, 216 consecutive adult intertrochanteric femoral fractures (OTA/AO type 31 A3) were retrospectively identified with intramedullary nail fixation from 2004 through 2013. Of these, 193 patients (58.5% female) met the inclusion criteria. The average age was 70 years (range 19–96 years).ResultsCephalomedullary nails were utilized in 176 and reconstruction nails in 17 patients. After the index procedure, 86% healed uneventfully. Nonunion development was observed in 6% and 5% had an unscheduled reoperation due to implant or fixation failure. Active smoking was reported in 16.6%. Current smokers had an increased nonunion risk compared to those who do not currently smoke (15.6% vs. 4.3%; p = 0.016). The femoral neck angle averaged 128.0° ± 5°. Fixation failure occurred in 11.1% of patients with a neck-shaft-angle < 125° compared to 2.6% (4/155) of patients with a neck-shaft angle ≥125° (p = 0.021). Patients treated with a reconstruction nail required a second surgical intervention in 23.5%, which was no different compared to 25.0% in the cephalomedullary group (p = 0.893). In the cephalomedullary group, 4.5% developed a nonunion compared to 23.5% in the reconstruction group (p = 0.002). Painful hardware led to hardware removal in 8.8%. All of them were treated with a cephalomedullary device (p = 0.180). During the last office visit, two-thirds of the patients reported no or only mild pain but most patients had reduced hip range of motion.ConclusionIntramedullary nailing is a reliable surgical technique when performed with adequate reduction. Varus reduction with a neck-shaft angle < 125° resulted in an increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking increased nonunion formation. Utilization of a cephalomedullary device reduced the nonunion rate, but had higher rates of painful prominent hardware compared to reconstruction nailing.

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“… 5 Cephalomedullary nailing has gained popularity since its introduction in the 1980s. 6 Biomechanically, these nails act as an intramedullary buttress to prevent excessive shaft medialization. Clinically, studies suggest that cephalomedullary nailing may have shorter operative times, decreased blood loss, greater fixation stability, and shorter hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Are Cephalomedullary Nail Guides Accurate? A Case Report of an Unexpected Complication After Nailing an Intertrochanteric Femoral Fracture

Fairag

Abduljabbar

Page

et al. 2018

Geriatr Orthop Surg Rehabil

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Intramedullary nailing is the mainstay of treatment for unstable intertrochanteric hip fractures. Various complications have been described with the use of these nails. We report an unusual complication whereby the lag screw completely missed the nail. We hypothesize that this previously unreported complication may be related to a specific flexible carbon fiber aiming device. Surgeon awareness and thorough intraoperative imaging are crucial to avoiding this complication.

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Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up

Cited by 55 publications

References 15 publications

Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture

Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

Are Cephalomedullary Nail Guides Accurate? A Case Report of an Unexpected Complication After Nailing an Intertrochanteric Femoral Fracture

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