Skip to main content

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

Archives of Orthopaedic and Trauma Surgery (2021)Cite this article

Abstract

Objectives

The purpose of the study was to compare treatment outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures.

Data sources

A systematic review of perioperative outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures was performed. The following databases were used: using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980–2019), and MEDLINE (1980–2019). The queries were performed in June 2019.

Study selection

The following search term query was used: “Intramedullary Nail AND Intertrochanteric Fracture OR “Long OR Short Nail AND intertrochanteric Fracture.” Studies were excluded if they were “single-arm” studies (i.e., reporting on either long or short CMN but not both), or did not report at least one of the outcomes being meta-analyzed. Furthermore, cadaveric studies, animal studies, basic science articles, editorial articles, surveys and studies were excluded.

Data extraction

Two investigators independently reviewed abstracts from all identified articles. Full-text articles were obtained for review if necessary, to allow further assessment of inclusion and exclusion criteria. Additionally, all references from the included studies were reviewed and reconciled to verify that no relevant articles were missing from the systematic review.

Data synthesis

Short nails were associated with statistically significantly less estimated blood loss and operative time compared to long nails. There were no significant differences in transfusion rates, implant failures or overall re-operation rates between implant lengths. Similarly, there was no significant difference in peri-implant fracture between implant lengths.

Conclusions

Overall, the available clinical evidence supports the use of short cephalomedullary nails for the majority of intertrochanteric femur fractures.

Study design/level of evidence

Meta-analysis; Level III, therapeutic.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Niu E, Yang A, Harris AH, Bishop J (2015) Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the united states? a survey of orthopaedic surgeons. ClinOrthopRelat Res 473(11):3647–3655

    Google Scholar 

  2. Anglen JO, Weinstein JN (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg 90(4):700–707

    Article  Google Scholar 

  3. Werner BC, Fashandi AH, Gwathmey FW, Yarboro SR (2015) Trends in the management of intertrochanteric femur fractures in the United States 2005–2011. Hip Int 25(3):270–276

    Article  Google Scholar 

  4. Hulet DA, Whale CS, Beebe MJ, Rothberg DL, Gililland JM, Zhang C et al (2019) Short versus long cephalomedullary nails for fixation of stable versus unstable intertrochanteric femur fractures at a Level 1 Trauma Center. Orthopedics 42(2):e202–e209

    Article  Google Scholar 

  5. Shannon SF, Yuan BJ, Cross WW 3rd, Barlow JD, Torchia ME, Holte PK et al (2019) Short versus long cephalomedullary nails for pertrochanteric hip fractures: a randomized prospective study. J Orthop Trauma 33(10):480–486

    Article  Google Scholar 

  6. Liu J, Frisch NB, Mehran N, Qatu M, Guthrie ST (2018) Short-term medical complications following short versus long cephalomedullary nails. Orthopedics 41(5):e636–e642

    Article  Google Scholar 

  7. Krigbaum H, Takemoto S, Kim HT, Kuo AC (2016) Costs and Complications of short versus long cephalomedullary nailing of OTA 31–A2 proximal femur fractures in US veterans. J Orthop Trauma 30(3):125–129

    Article  Google Scholar 

  8. Dunn J, Kusnezov N, Bader J, Waterman BR, Orr J, Belmont PJ (2016) Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review. J OrthopTraumatol 17(4):361–367

    Google Scholar 

  9. Boone C, Carlberg KN, Koueiter DM, Baker KC, Sadowski J, Wiater PJ et al (2014) Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31–A1 and A2). J Orthop Trauma 28(5):e96–e100

    Article  Google Scholar 

  10. Frisch NB, Nahm NJ, Khalil JG, Les CM, Guthrie ST, Charters MA (2017) Short versus long cephalomedullary nails for pertrochanteric hip fracture. Orthopedics 40(2):83–88

    Article  Google Scholar 

  11. Guo XF, Zhang KM, Fu HB, Cao W, Dong Q (2015) A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly. Chin J Traumatol 18(6):332–335

    Article  Google Scholar 

  12. Okcu G, Ozkayin N, Okta C, Topcu I, Aktuglu K (2013) Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail? Clin Orthop Relat Res 471(9):2768–2775

    Article  Google Scholar 

  13. Kleweno C, Morgan J, Redshaw J, Harris M, Rodriguez E, Zurakowski D et al (2014) Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma 28(7):391–397

    Article  Google Scholar 

  14. Li Z, Liu Y, Liang Y, Zhao C, Zhang Y (2015) Short versus long intramedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. Int J ClinExp Med 8(4):6299–6302

    Google Scholar 

  15. Kanakaris NK, Tosounidis TH, Giannoudis PV (2015) Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked. J Orthop Trauma 29(Suppl 4):S10–S16

    Article  Google Scholar 

  16. Hou Z, Bowen TR, Irgit KS, Matzko ME, Andreychik CM, Horwitz DS et al (2013) Treatment of pertrochanteric fractures (OTA 31-A1 and A2): long versus short cephalomedullary nailing. J Orthop Trauma 27(6):318–324

    Article  Google Scholar 

  17. Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg 85(1):1–3

    Article  Google Scholar 

  18. Schumm WR, Higgins M, Lockett L, Huang S, Abdullah N, Asiri A et al (2017) Does dividing the range by four provide an accurate estimate of a standard deviation in family science research? a teaching editorial. Marriage Fam Rev 53(1):1–23

    Article  Google Scholar 

  19. Shin WC, Lee ES, Suh KT (2018) The difference between short and long intramedullary nailing as the treatment for unstable intertrochanteric femoral fracture (AO/OTA 31-A2) in elderly patients. J Korean OrthopAssoc 52(1):25–32

    Article  Google Scholar 

  20. Sellan M, Bryant D, Tieszer C, Papp S, Lawendy A, Liew A et al (2019) Short versus long InterTAN fixation for geriatric intertrochanteric hip fractures: a multicentre head-to-head comparison. J Orthop Trauma 33(4):169–174

    Article  Google Scholar 

  21. Luo X, He S, Li Z, Li Q (2020) Quantification and influencing factors of perioperative hidden blood loss during intramedullary fixation for intertrochanteric fractures in the elderly. Arch Orthop Trauma Surg 140(10):1339–1348

    Article  Google Scholar 

  22. Luque Pérez R, ChecaBetegón P, Galán-Olleros M, Arvinius C, Valle-Cruz J, Marco F (2020) Nailing unstable pertrochanteric fractures: does size matters? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03668-0

    Article  PubMed  Google Scholar 

  23. Robinson CM, Adams CI, Craig M, Doward W, Clarke MC, Auld J (2002) Implant-related fractures of the femur following hip fracture surgery. J Bone Joint Surg 84(7):1116–1122

    CAS  Article  Google Scholar 

  24. Bhandari M, Schemitsch E, Jonsson A, Zlowodzki M, Haidukewych GJ (2009) Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis. J Orthop Trauma 23(6):460–464

    Article  Google Scholar 

  25. Vaughn J, Cohen E, Vopat BG, Kane P, Abbood E, Born C (2014) Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up. Eur J OrthopSurgTraumatol 25(4):665–670

    Google Scholar 

  26. Murena L, Moretti A, Meo F, Saggioro E, Barbati G, Ratti C et al (2018) Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg 138(3):351–359

    Article  Google Scholar 

  27. Hong CC, Nashi N, Makandura MC, Tan JH, Peter L, Murphy D (2017) The long and short of cephalomedullary nails in the treatment of osteoporotic pertrochanteric fracture. Singap Med J 58(2):85–91

    Article  Google Scholar 

  28. Zhang W, Antony Xavier RP, Decruz J, Chen YD, Park DH (2020) Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03399-2

    Article  PubMed  Google Scholar 

  29. Horwitz DS, Tawari A, Suk M (2016) Nail length in the management of intertrochanteric fracture of the femur. J Am AcadOrthopSurg 24(6):e50–e58

    Google Scholar 

  30. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C (2009) Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma 23(7):485–492

    Article  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Affiliations

  1. Department of Orthopaedic Surgery, Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA, USA

    Mark E. Cinque, L. Henry Goodnough, Blake J. Schultz MD, Andrew T. Fithian, Malcolm DeBaun, Michael J. Gardner MD & Julius A. Bishop

  2. Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, CA, USA

    Justin F. Lucas

Authors
  1. Mark E. Cinque
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Henry Goodnough
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Blake J. Schultz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew T. Fithian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Malcolm DeBaun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Justin F. Lucas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael J. Gardner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Julius A. Bishop
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark E. Cinque.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cinque, M.E., Goodnough, L.H., MD, B.J.S. et al. Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-021-03752-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00402-021-03752-z

Keywords

  • Cephalomedullary nail
  • Intertrochanteric femur fracture
  • Long nail
  • Short nail