Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Abstract

BackgroundBoth long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures.Materials and methodsA literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay.ResultsIncluded in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P < 0.0001). No significant differences between short and long nails were observed for either other complications, hardware complications, non-union, or mortality.ConclusionsFor trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective.Level of evidenceLevel 3.

Comparison of Therapeutic Results of Using Short and Long Proximal Femoral Nail (PFN) in Patients with Intertrochanteric Fracture

“…But, Dunn (2016), reported the amount of received blood in the short nail group was 8.8% (39 ml) which was lower than that of the long nail group and thus both the groups were seen to be statistically differentiated from each other. We found the duration of surgery in the short PFN group was signif icantly lower than the PFN group which supports the result of Dunn (2016). In our study, the mean duration of the union in the long PFN group was shorter than the short PFN group, but the differences were not statistically signif icant.…”

“…Although the difference in therapeutic results from short and long PFNs is not explicitly stated, some studies have highlighted the cost of using long PFN, the surgical time, the amount of bleeding during surgery and its complications more than the short PFN. Also, the results of studies have shown that the use of long PFN does not reduce the chances of Periprosthetic fracture and reoperation (Dunn et al, 2016;Kanakaris ., 2015;Boone ., 2014;Kleweno ., 2014). In contrast to some studies, there was no signif icant difference between the clinical outcomes of the two methods, and both methods were useful in treating intertrochanteric fractures (Kleweno ., 2014;Vaughn , 2015;Okcu ., 2013).…”

“…(2014)'s study was lower than that the present study, but the similarity of two studies was a higher numberof revisions in the short nail group. In the study of Dunn . (2016), the rate of surgical revision in the short CMN group was 5% and in the long CMN group was 3.8%, which did not differ signif icantly.…”

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.…”

The "diagonal" principle in the surgery of femoral intertrochanteric fractures

“…Choosing between long or short nails during internal xation for intertrochanteric fractures in the elderly is still controversial. In 2016, John et al [8] . reported that short nails had a lower reoperation rate than long nails, and that short nails were associated with a shorter operation time, , less intraoperative blood loss, and lower hospitalization costs.…”