Abstract
Introduction
Hip fractures are becoming increasingly common resulting in significant morbidity, mortality and raising healthcare costs. Both short and long cephalomedullary devices are currently employed to treat intertrochanteric hip fractures. However, which device is optimal continues to be debated as each implant has unique characteristics and theoretical advantages. This study looked to identify rates of complications associated with both long and short cephalomedullary nails for the treatment of intertrochanteric hip fractures.
Methods
We retrospectively reviewed charts from 2006 to 2011, and we identified 256 patients were identified with AO class 31.1–32.3 fractures. Sixty were treated with short nails and 196 with long nails. Radiographs and charts were then analysed for failures and hardware complications.
Results
Catastrophic failure and hardware complication rates were not statistically different between short or long cephalomedullary nails. The overall catastrophic failure rate was 3.1 %; there was a 5 % failure rate in the short-nail group compared with a 2.6 % failure rate in the long-nail group (p = 0.191). There was a 3.33 % secondary femur fracture rate in the short-nail group, compared with none in the long-nail cohort (p = 0.054). The rate of proximal fixation failure was 1.67 % for the short-nail group and 2.0 % in the long-nail group (p = 0.406).
Discussion
Our data suggests equivocal outcomes as measured by similar catastrophic failure rate between both short and long cephalomedullary nails for intertrochanteric femur fractures. However, there was an increased risk of secondary femur fracture with short cephalomedullary nails when compared to long nails that approached statistical significance.
Similar content being viewed by others
References
Brauer CA et al (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7(5):407–413
Adams CI et al (2001) Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma 15(6):394–400
Parker M, Johansen A (2006) Hip fracture. BMJ 333(7557):27–30
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 (American volume)
Radcliff TA, Regan E, Ripley DCC et al (2012) Increased use of intramedullary nails for intertrochanteric proximal femoral fractures in veterans affairs hospitals: a comparative effectiveness study. J Bone Joint Surg Am 94:833–840
Kokoroghiannis C, Aktselis I, Deligeorgis A et al (2012) Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures—a review. Injury 43:686–693
Davis J et al (1991) Pertrochanteric fractures treated with the Gamma nail: technique and report of early results. Orthopedics 14(9):939–942
Lindsey RW et al (1991) Early experience with the gamma interlocking nail for peritrochanteric fractures of the proximal femur. J Trauma 31(12):1649–1658
Norris R, Bhattacharjee D, Parker MJ (2012) Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury 43(6):706–711
Boone C, Carlberg KN, Koueiter DM et al (2013) Short versus long nail for intertrochanteric fracture. J Orthop Trauma
Parker MJ, Handoll HH (2008) Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 3:CD000093
Radford PJ, Needoff M, Webb JK (1993) A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br 75(5):789–793
Saudan M et al (2002) Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma 16(6):386–393
Conflict of interest
Dr. Born reports personal fees and other from Consultancy—Stryker, grants from Stryker, personal fees from Stock/Stock Options through Illuminos, Biointraface, outside the submitted work. The remaining authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vaughn, J., Cohen, E., Vopat, B.G. et al. Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up. Eur J Orthop Surg Traumatol 25, 665–670 (2015). https://doi.org/10.1007/s00590-014-1557-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-014-1557-2