A systematic review of short versus long intramedullary fixation in the management of pertrochanteric fractures

Abstract

Introduction: The aim was to determine whether there is a significant difference in clinical outcomes when using short vs. long nails for pertrochanteric femur fractures. Methods: A systematic literature search was undertaken of Pubmed and Embase in April 2016. All papers published in English reporting studies comparing long vs. short nails for pertrochanteric femur fractures were studied. Data were pooled for blood loss and transfusion requirement, operative time, length of stay, incidence of delayed or non-union, incidence of avascular necrosis or infection, fracture or metalware failure and was analysed to examine the differences between long and short nails. Results: From 90 potential studies, nine were considered to be eligible for inclusion. The short nail resulted in a statistically significant benefit when looking at transfusion requirement (p ¼ 0.02); however, blood loss was not statistically different (p ¼ 0.33) Operative time was also quicker with the short nail (p ¼ 0.004), but the length of stay was no different (p ¼ 0.41). When examining complications and fixation outcomes, there was no difference in delayed union rates (p ¼ 0.29) and non-union rates (p ¼ 0.19) nor when looking at metalware failure (p ¼ 0.41) and fracture (p ¼ 0.14). Discussion: The use of short intramedullary nails for pertrochanteric femur fractures appeared to be beneficial when looking at transfusion requirements and operative time. When looking at complications such as fracture and metalware failure, despite there being a slightly higher incidence of these in the short nail group, it is not statistically significant. This study advocates that both devices are safe to use, however, the short nail may have some perceived benefits in reducing transfusion requirements and have cost benefits with a shorter operative time.

Clinical outcomes following long versus short cephalomedullary devices for fixation of extracapsular hip fractures: a systematic review and meta-analysis

“…Estimated blood loss between the groups favoured the use of short CMDs over long CMDs, with the pooled data showing a statistically significant difference between the two groups. This has also been reported in the existing literature, with short CMDs showing a consistently lower blood loss over long CMDs 36 , 38 . The lower blood loss may also confer more advantages towards the use of a short nail, such as a reduction in the transfusion requirements, which had also been reported in 2 of the studies included 25 , 26 .…”

Comparison of outcomes of Long versus Short Cephalomedullary nails for the fixation of intertrochanteric femur fractures: A Protocol for Systematic Review and Meta-analysis

“…There are published reviews on the current topic, however, with a limited number of articles and outcomes. [8][9][10][11] Hence, further analysis is needed for the evidence of the superiority of one implant over another, including a maximum number of published studies. Therefore, the current review aims to perform a systematic review and meta-analysis of the current literature to compare the outcomes of IFF internal fixation with short CMN versus long CMN.…”

“…[7] In terms of design, although both short and long CMNs are suitable for the fixation of IFF, the use of short CMNs has reported advantages of shorter surgical duration, lesser intraoperative blood loss, and blood transfusion. [8] On the other hand, long CMNs have the theoretical advantage of minimizing stress concentration near the distal end of the nail, hence potentially decreasing the occurrence of secondary fractures of the shaft femur [9]. However, the superiority of one design over the other has been a matter of debate despite multiple studies in the literature.…”

“…However, the superiority of one design over the other has been a matter of debate despite multiple studies in the literature. [8][9][10]…”

Cost-effectiveness analysis of short versus long cephalomedullary nails for treatment of stable intertrochanteric femoral fractures: a theoretical cohort study

“…28 Literature regarding differences in operative times between LNs and SNs have shown a mean operative time of 62.68 minutes for LNs and 50.57 min for SNs (P = 0.004). 18 Costs of red blood cell (RBC) transfusions (BT) were based on literature citing a mean cost of $893 per RBC unit in 2020 USD. 29 In three studies included in the systematic review that was used to base the clinical outcomes, LN had a BT rate of 53.1% compared to 41.3% for SN (P = 0.02) and a range of one to three RBC units were transfused.…”