Short Versus Long Cephalomedullary Nails for the Treatment of Intertrochanteric Hip Fractures in Patients Older than 65 Years

Abstract

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The long and short of cephalomedullary nails in the treatment of osteoporotic pertrochanteric fracture

“…This finding is in contrast to the findings of Hou et al and Boone et al (14,19) Several authors attributed the increase in surgical time and estimated blood loss among patients who had insertions of long cephalomedullary nails to additional reaming of the femoral canal and the insertion of the distal interlocking screw. (4,14,20) We are in agreement with these postulations, especially in a setting where the use of short nails allows the additional benefit of an accompanying jig on which to place the distal interlocking screw, making the procedure easier and faster. The differences between our study and other studies that we observed could be due to our relatively smaller study population and inherent heterogeneity in the surgeons' individual implantation techniques.…”

“…(4,5,(10)(11)(12)(13)20) Several studies have reported no significant difference in outcome with the use of long or short intramedullary nails to treat simple and multifragmentary pertrochanteric fractures; however, those studies did not consider the presence of osteoporosis in their analysis. (14,19) Hence, the aim of the present study was to review the complications and functional In recent years, there has been growing concern regarding the high risk of implant cut-out in the management of osteoporotic pertrochanteric fractures, as was aptly described by Konstantinidis et al in their cadaveric study.…”

“…(19) Following that, Kleweno et al's review of 559 patients also did not find any significant difference between the failure rates of short and long cephalomedullary nails used for the treatment of intertrochanteric hip fractures. (20) The study similarly did not discuss whether the patients had osteoporosis and the severity of the disease, or compare how osteoporotic patients differed from non-osteoporotic patients in terms of the outcome of the use of short or long cephalomedullary nails. However, the study consisted of patients over the age of 65 years.…”

“…However, the study consisted of patients over the age of 65 years. (20) It was hence likely that a large proportion of the patients were osteoporotic, although no specific diagnostic tools were used to diagnose osteoporosis.…”

“…Based on our literature review, only three studies have attempted to compare the outcomes of the use of long cephalomedullary nails with the use of short cephalomedullary nails in the management of OTA Class 31-A1 and Class 31-A2 pertrochanteric fractures. (14,19,20) These studies were largely of elderly populations, which have a high probability of underlying osteoporosis based on their age alone. However, none of these studies employed objective evaluation tools to diagnose and study the extent of osteoporosis.…”