Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients

Cinque, Mark E.; Goodnough, L. Henry; Schultz, Blake J; Fithian, Andrew; DeBaun, Malcolm R.; Lucas, Justin F.; Gardner, Michael J.; Bishop, Julius A.

doi:10.1007/s00402-021-03752-z

Cited by 13 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a cohort of nearly 8,000 patients undergoing hip fracture repair, the overall revision rates were comparable between implants, as well as between TFNA implants using lag screws compared with helical blades. Revision rates were slightly lower than previously reported rates of general reoperation for cephalomedullary nails (6.9% to 8.4%) in a recent systematic review 18 . The revision rates for cut-out were low (1.1%) and were comparable with previously reported values of 2% to 7% 7,[19][20][21] .…”

Section: Discussioncontrasting

confidence: 72%

Risk of Revision After Hip Fracture Fixation Using DePuy Synthes Trochanteric Fixation Nail or Trochanteric Fixation Nail Advanced

Goodnough

Chang

Fasig

et al. 2022

Journal of Bone and Joint Surgery

Self Cite

View full text Add to dashboard Cite

Background: Prior reports of the DePuy Synthes Trochanteric Fixation Nail Advanced (TFNA) revealed a potential mode of fatigue failure at the proximal screw aperture following fixation of extracapsular hip fractures. We sought to compare the revision risk between the TFNA and its prior-generation forebear, the Trochanteric Fixation Nail (TFN).Methods: A retrospective cohort study was performed using data from a U.S. integrated health-care system's hip fracture registry. The study sample comprised patients who underwent cephalomedullary nail fixation for hip fracture with a TFN (n = 4,007) or TFNA (n = 3,972) from 2014 to 2019. We evaluated the charts and radiographs for patients who underwent any revision. Multivariable Cox regression was used to evaluate the risk of revision related to the index fracture.Results: At the 3-year follow-up, the cumulative probability of revision related to the index fracture was 1.8% for the TFN and 1.9% for the TFNA. After adjustment for covariates, no difference was observed in revision risk (hazard ratio [HR], 1.18 [95% confidence interval (CI), 0.80 to 1.75]; p = 0.40) for the TFNA compared with the TFN. The TFNA was associated with a higher risk of revision for nonunion than the TFN (HR, 1.86 [95% CI, 1.11 to 3.12]; p = 0.018). At the 3-year followup, implant breakage was 0.06% for the TFN and 0.2% for the TFNA; with regard to aperture failures related to the index fracture, there were 1 failure for the TFN group and 3 failures for the TFNA group.Conclusions: In a large cohort from a U.S. hip fracture registry, the TFNA had an overall revision rate that was similar to that of the earlier TFN, with implant breakage being a rare revision reason for both groups. Chart and radiographic review found that the TFNA was associated with a higher risk of revision for nonunion.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Implant breakage remains a risk after operative fixation of extracapsular proximal femoral fractures using cephalomedullary nails and is estimated to occur in 2% to 3% of cases despite contemporary implant designs 1-3 . Although earlier modes of failure may be less common, the continued evolution and introduction of new cephalomedullary nails have the potential to yield unexpected unique failure patterns. Furthermore, in spite of advances in design, a revision surgical procedure for lateral implant prominence, implant cut-out, or nonunion remains a risk 4-6 .As with other cephalomedullary designs, the DePuy Synthes Trochanteric Fixation Nail (TFN) has been associated with revision for blade or screw cut-out in the head, although these observations were only described in single-center series [4][5][6][7][8] . With multiple design changes to better accommodate the osseous anatomy of the proximal part of the femur, the Synthes Trochanteric Fixation Nail Advanced (TFNA) was introduced in 2014 as a successor to the TFN 9 . The specific modifications to the TFNA included a reduction of the proximal dia...

show abstract

Section: Discussioncontrasting

confidence: 72%

Risk of Revision After Hip Fracture Fixation Using DePuy Synthes Trochanteric Fixation Nail or Trochanteric Fixation Nail Advanced

Goodnough

Chang

Fasig

et al. 2022

Journal of Bone and Joint Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Overall, no difference in general failure and reoperation rates between the nail groups was found in the systematic reviews/meta-analysis studies, and similar findings were reported in 5 of the additional articles analyzed. 19,27,31,34,36 Peri-implant fracture rates reported in the meta-analyses were higher for the short nails with a rate of 1.97% compared with 0.64% for the long nails, 17 although this difference was not significant. Similar findings were reported in 4 of the additional studies.…”

Section: Resultsmentioning

confidence: 88%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Davidson,

Giannoudis

2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objective: The objective of this study was to compare clinical outcomes of patients with trochanteric hip fractures treated with specific different cephalomedullary nail (CMN) designs. Methods: A scoping review of the English literature was performed. Inclusion criteria were studies comparing perioperative and postoperative outcomes of trochanteric hip fractures fixated by CMNs for one of the following CMN designs: short versus long nails, blade versus screw fixation, dual versus single lag screw fixation, and application of cement augmentation. Inclusion criteria consisted of human comparative clinical trials (randomized and observational). Exclusion criteria included noncomparative studies, studies comparing CMN with non-CMN devices or with arthroplasty, studies with less than 3 months follow-up, studies that did not provide relevant clinical outcome measures, biomechanical, finite element analyses, animal, or in vitro publications. Data regarding reoperations, peri-implant fractures, mechanical failure, nonunion, infection rates, and functional outcomes were reviewed. Results: Twenty-two studies met the inclusion criteria and formed the basis of this study. Failure of fixation rates and reoperation rates for each of the nail designs selected for evaluation is presented, in addition to specific outcome measures relevant to that nail design which was explored: peri-implant fracture—short versus long nails, and specific mechanism of failure—blade versus plate. Conclusions: Decreased failure of fixation and reoperations rates were found for integrated dual lag screw fixation. Similar fixation failure and reoperation rates were found for the long versus short nails and for blade versus screw fixation. Level of Evidence: Diagnostic, Level IV.

show abstract

“…This includes those who have multiple medical comorbidities, and the elderly. The decrease in the amount of time under anaesthesia could be advantageous for these patients as it may decrease the risk of perioperative complications 13 , 40 . However, this should also be weighed against benefit in long-term outcomes that have been shown with the use of a long CMD.…”

Section: Discussionmentioning

confidence: 99%

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

Tan

Chong

Razak

2021

Sci Rep

View full text Add to dashboard Cite

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.

show abstract

Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients

Cited by 13 publications

References 26 publications

Risk of Revision After Hip Fracture Fixation Using DePuy Synthes Trochanteric Fixation Nail or Trochanteric Fixation Nail Advanced

Risk of Revision After Hip Fracture Fixation Using DePuy Synthes Trochanteric Fixation Nail or Trochanteric Fixation Nail Advanced

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

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

Contact Info

Product

Resources

About