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

Abstract

INTRODUCTION Pertrochanteric fractures after low-energy trauma are common among osteoporotic patients. Although the use of intramedullary devices to treat such fractures is becoming increasingly popular, there is a paucity of data comparing the outcomes of the use of short cephalomedullary nails (SCN) with the use of long cephalomedullary nails (LCN). This study aimed to compare the outcomes of treatment using LCN with treatment using SCN for patients with osteoporotic pertrochanteric fractures.METHODS A retrospective review of 64 patients with osteoporotic pertrochanteric fractures who were treated with either LCN or SCN and had a minimum follow-up of one year was performed. Primary outcome measures include complications, revision surgeries and union rates. Secondary outcome measures include duration of surgery, estimated blood loss, length of hospital stay, and ambulatory and mortality status at one year. RESULTSThere was no significant difference in the clinical and functional outcomes of the patients who were treated with LCN and those who were treated with SCN. However, there was a higher incidence of heterotopic ossification in the latter group, and a slightly greater average estimated blood loss and duration of surgery in the former group. Patients treated with LCN tended to be more osteoporotic.CONCLUSION Our study found no significant difference in terms of complications, revision surgeries, union rates and ambulatory status between the patients who were treated with LCN and those who were treated with SCN. Both LCN and SCN provided safe and reliable outcomes in the treatment of osteoporotic pertrochanteric fractures.

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

“…One factor that impacts complication rates, especially of intramedullary nail implants, is the dimension of the nail, i.e. long or short nails [ 22 , 31 – 33 ]. In four out of the six studies, nail dimensions were reported and the range for InterTAN was 18–20 cm whilst PFNA was 20 to 28 cm which are deemed to be short nails.…”

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.…”