Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis

Zhang, Y; Zhang, S; Wang, S; Zhang, H; Zhang, W; Liu, P; Ma, Jian-Xing; Pervaiz, Nabeel; Wang, J

doi:10.1016/j.otsr.2017.04.003

Cited by 40 publications

(25 citation statements)

References 20 publications

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“…Despite the significant differences, we were not able to correlate these results with the functional outcome. Zhang et al also demonstrated that the operative time does not influence the average length of hospital stay (25). We also found that the intraoperative blood loss was significantly higher in the long nail group.…”

Section: Discussionsupporting

confidence: 74%

“…After 12 months, the short nail group still showed better results, but not statistically significant; thus, the length of the nail may not influence the long-term functional result (P=0.28). In the literature, we found studies that demonstrated acceptable and comparable results regarding HHS (22)(23)(24)(25). Sellan et al observed a better HHS for the short nail group, but did not find any significance from the clinical point of view.…”

Section: Discussionmentioning

confidence: 74%

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Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

Dragosloveanu

Cotor

et al. 2021

Exp Ther Med

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In unstable pertrochanteric fractures, there are still debates regarding the complications and long-term benefits after internal fixation using short or long cephalomedullary nails. Therefore, a study was developed regarding this idea. From May 2017 to April 2020, 61 patients with unstable (AO 31-A2) and intertrochanteric fractures (AO 31-A3) were surgically operated on. During follow-up, 8 patients were excluded (lost or deceased). A total of 26 patients received internal short nail system fixation and 27 received a long nail system. All cases followed the standard 6-week rehabilitation protocol. Follow-up was at 3, 6 weeks, 3, 6 and 12 months, and clinical and functional assessment were determined by a different surgeon using the Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Functional Ambulation Categories (FAC). A total of 42 (79.2%) had a 31.A2 fracture (21 in the long nail group and 21 in the short nail group) and 11 (20.8%) had a 31.A3 fracture (6 in long nail group and 5 in the short nail group). Surgical time was significantly longer (P<0.05) in the long nail group (an average of 81.38±12.01 min), compared with the short nail group (53.11±8.36 min). Blood loss was significantly higher (P<0.05) in the long nail group (210±12.1 ml) compared to the short nail group (75.4±14.8 ml). No statistical differences were noted regarding tip-apex distance (TAD) and VAS score. At 6 months, HHS was better for the short nail group (84.76±3.68) (P<0.05). Regarding the FAC scale, no significant statistical differences were identified. Cut-out occurred in 2 cases in the short nail group and 1 case from the long nail group. Only 1 peri-implant fracture occurred in a patient with a long cephalomedullary nail.In conclusion, the long cephalomedullary nail requires a longer surgical time and is associated with an increase in intraoperative blood loss without improving the functional outcome after 12 months postoperatively. A larger sample of cases is required to thoroughly analyze the postoperative complications.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 74%

Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

Dragosloveanu

Cotor

et al. 2021

Exp Ther Med

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“…[6][7][8][9]18,19 In previous studies the comparison between short and long cephalomedullary nails focused on blood loss perioperative, time in theatre and cut out, but early and later studies do also compare complications for short and long cephalomedullary nails. A systematic review from 2017 20 comparing short and long intramedullary nails for OTA A1, A2 and A3 trochanteric fractures included 10 studies and their meta-analysis showed no difference in risk of complications, but supports the findings with reduced blood loss and time in theatre. In our study all patients were operated with third generation Gamma Nail.…”

Section: Discussionmentioning

confidence: 70%

Failure of short versus long cephalomedullary nail after intertrochanteric fractures

Bovbjerg

Larsen

Madsen

et al. 2020

Journal of Orthopaedics

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The aim of study is to examine the frequency of reoperation and difference in failures for short cephalomedullary nail (SN) and long cephalomedullary nail (LN).We included patients with an intertrochanteric fracture treated with Gamma nail (Stryker®). All radiographs were reviewed, TAD and diastasis were measured, and type of failure registered.216 patients were included, 95 short nails and 121 long nails. We found 12 reoperations, 5 in the SN group and 7 in the LN group. Most common failure was cut out. Our study showed no difference in frequency of reoperations or type of failures.

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“…. Registry studies were unable to find any differences in all-cause revision or periprosthetic fractures when comparing short to long cephalomedullary nails; long nails, however, took longer to implant and led to more estimated blood loss and hospitalization time; length of stay and mortality were similar [207][208][209][210]. A systematic review comparing short and long nails for extracapsular hip fractures was unable to demonstrate a clinically significant difference in outcome, and there is no good evidence to support long over short intramedullary devices, according to the authors [211].…”

Section: Extracapsular Hip Fracturesmentioning

confidence: 99%

Orthogeriatric Care: Reviewing Improvements in Outcomes

Tarazona-Santabalbina¹,

Ojeda-Thies²,

Rodríguez³

et al. 2021

Preprint

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis

Abstract: III.

Cited by 40 publications

References 20 publications

Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

Failure of short versus long cephalomedullary nail after intertrochanteric fractures

Orthogeriatric Care: Reviewing Improvements in Outcomes

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