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

Abstract

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.

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

“…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.…”

“…19,27,31,36 However, the long nails were associated with increased estimated blood loss (EBL) and longer operative time. 17,19,27,31,[34][35][36] Interestingly, one study demonstrated a weighted mean difference of 17.57 minutes in operative time in favor of the short CMN group (P , 0.05) and estimated 60 mL reduced EBL. 17 No difference between the 2 nail groups was reported for mean length of hospitalization, 31,34,36 1 year mortality rate, 17,27,31,34,36 nonmechanical complication rate, 1,27,31,36 and patient-reported outcome measures.…”

“…Between January 2000 and March 2023, of 659 articles screened, 22 met the inclusion criteria and formed the basis of this study. 7,16–36…”

“…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.…”

“…Similar findings were reported in 4 of the additional studies. 19,27,31,36 However, the long nails were associated with increased estimated blood loss (EBL) and longer operative time. 17,19,27,31,[34][35][36] Interestingly, one study demonstrated a weighted mean difference of 17.57 minutes in operative time in favor of the short CMN group (P , 0.05) and estimated 60 mL reduced EBL.…”