Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture

Abstract

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.].

Similar function and complications for patients with short versus long hip nailing for unstable pertrochanteric fractures

“…Recent studies did not report a difference in function between patients with pertrochanteric fractures treated with either a short or a long intramedullary hip nail [ 4 , 20 ]. Similarly, other studies [ 5 , 11 ] reported similar function, fracture healing and revision rates with a short or a long intramedullary hip nail, and a shorter operative time with a short hip nail.…”

“…Similarly, other studies [ 5 , 11 ] reported similar function, fracture healing and revision rates with a short or a long intramedullary hip nail, and a shorter operative time with a short hip nail. Additionally, these studies emphasize on a higher rate of complications with short versus long intramedullary hip nailing [ 4 , 5 , 11 , 20 ]. An overall rate of periprosthetic femoral fractures ranging from 0 to 20% has been reported in patients treated with short intramedullary hip nails for pertrochanteric fractures [ 4 ]; some authors believe that long intramedullary nails protect the entire femur from periprosthetic fractures [ 4 ] while others report no difference in complications [ 20 ].…”

“…Additionally, these studies emphasize on a higher rate of complications with short versus long intramedullary hip nailing [ 4 , 5 , 11 , 20 ]. An overall rate of periprosthetic femoral fractures ranging from 0 to 20% has been reported in patients treated with short intramedullary hip nails for pertrochanteric fractures [ 4 ]; some authors believe that long intramedullary nails protect the entire femur from periprosthetic fractures [ 4 ] while others report no difference in complications [ 20 ]. We concur with these studies reporting periprosthetic fractures as a complication of short intramedullary hip nailing [ 4 , 5 , 11 , 20 ]; periprosthetic fractures after short intramedullary nailing have been reported for all types of hip fractures, and the accurate fracture pattern seems to be an independent factor.…”

“…An overall rate of periprosthetic femoral fractures ranging from 0 to 20% has been reported in patients treated with short intramedullary hip nails for pertrochanteric fractures [ 4 ]; some authors believe that long intramedullary nails protect the entire femur from periprosthetic fractures [ 4 ] while others report no difference in complications [ 20 ]. We concur with these studies reporting periprosthetic fractures as a complication of short intramedullary hip nailing [ 4 , 5 , 11 , 20 ]; periprosthetic fractures after short intramedullary nailing have been reported for all types of hip fractures, and the accurate fracture pattern seems to be an independent factor. Although our results showed similar complications between the two groups of patients, the periprosthetic fracture should probably be considered a complication related to the length of the nail.…”

“…The classification proposed by AO/OTA into stable and unstable fractures is very useful in the clinical setting. The unstable pertrochanteric fractures (AO/OTA 31A2 and 31A3) and especially the reverse oblique variants (AO/OTA 31A3) have specific biomechanical patterns such as the lack of medial buttress that make their treatment challenging [ 3 , 4 ].…”