Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures

Womble, Tanner N; Kirk, Andrew; Boyle, Maxwell; Comadoll, Shea; Su, Leon; Srinath, Arjun; Matuszewski, Paul E.; Aneja, Arun

doi:10.5435/jaaosglobal-d-21-00322

Cited by 9 publications

(11 citation statements)

References 39 publications

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“…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. 35,36 Two articles also performed a cost-effective analysis and reported higher costs for the long nail group. 24,31…”

Section: Resultsmentioning

confidence: 99%

“…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…”

Section: Resultsmentioning

confidence: 99%

“…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. 35,36 Two articles also performed a cost-effective analysis and reported higher costs for the long nail group.…”

Section: Resultsmentioning

confidence: 99%

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

Davidson,

Giannoudis

2023

Journal of Orthopaedic Trauma

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Objective: The objective of this study was to compare clinical outcomes of patients with trochanteric hip fractures treated with specific different cephalomedullary nail (CMN) designs. Methods: A scoping review of the English literature was performed. Inclusion criteria were studies comparing perioperative and postoperative outcomes of trochanteric hip fractures fixated by CMNs for one of the following CMN designs: short versus long nails, blade versus screw fixation, dual versus single lag screw fixation, and application of cement augmentation. Inclusion criteria consisted of human comparative clinical trials (randomized and observational). Exclusion criteria included noncomparative studies, studies comparing CMN with non-CMN devices or with arthroplasty, studies with less than 3 months follow-up, studies that did not provide relevant clinical outcome measures, biomechanical, finite element analyses, animal, or in vitro publications. Data regarding reoperations, peri-implant fractures, mechanical failure, nonunion, infection rates, and functional outcomes were reviewed. Results: Twenty-two studies met the inclusion criteria and formed the basis of this study. Failure of fixation rates and reoperation rates for each of the nail designs selected for evaluation is presented, in addition to specific outcome measures relevant to that nail design which was explored: peri-implant fracture—short versus long nails, and specific mechanism of failure—blade versus plate. Conclusions: Decreased failure of fixation and reoperations rates were found for integrated dual lag screw fixation. Similar fixation failure and reoperation rates were found for the long versus short nails and for blade versus screw fixation. Level of Evidence: Diagnostic, Level IV.

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Section: Resultsmentioning

confidence: 99%

“…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…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Davidson,

Giannoudis

2023

Journal of Orthopaedic Trauma

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“…The patient's history of atrial fibrillation and multiple myeloma increases her risk of a thromboembolic event 17 . Intramedullary reaming is associated with significant embolic loads and cardiopulmonary complications 18,19 . Although TEE did not note any large emboli in this patient, microemboli caused by reaming likely occurred during the observed dysrhythmias 20 .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Dysrhythmias Cease After Venting During Intramedullary Nailing of an Impending Femur Fracture

Martinez

Dugdale

Sims

et al. 2023

JBJS Case Connector

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Case: A 76-year-old woman with multiple myeloma and osteoporosis presented with right hip pain and an impending atypical femoral fracture in the setting of chronic bisphosphonate use. After preoperative medical optimization, she was scheduled for prophylactic intramedullary nail fixation. Intraoperatively, the patient experienced episodes of severe bradycardia and asystole associated with intramedullary reaming, which ceased after distal venting of the femur. No additional intraoperative or postoperative complications were encountered, and the patient recovered uneventfully. Conclusion: Femoral canal venting may be an appropriate intervention for similar transient dysrhythmias caused by intramedullary reaming. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C72).

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“…In addition, we did not perform a sub-analysis of outcomes between patients treated with long vs short intramedullary devices due to limited numbers. While blood loss has been shown to greater in patients treated with long IMNs compared to short, 20 the focus of this study was directed at the type of procedure (eg, hemi vs nail). In our study, the rate of transfusion was higher in patients with an intramedullary nail (27%) vs other procedures (13.8%).…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid Administration at Hospital Admission Decreases Transfusion Rates in Geriatric Hip Fracture Patients Undergoing Surgery

Moran

Kahan

Morris

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction The timing of tranexamic acid (TXA) administration in fragility hip fracture patients is controversial. Prior studies have demonstrated reduction in transfusion requirements using the two-dose arthroplasty model. However, unlike arthroplasty patients whose bleeding starts at the time of surgical incision, hip fractures have an onset of bleeding at the time of the injury. The primary goal of this study was to evaluate the optimal timing of TXA administration and to determine its effect on red blood cell transfusions in fragility hip fracture patients. Methods All patients admitted to the fragility hip fracture service from April 1, 2019 to September 30, 2019 were prospectively screened for inclusion in the study. Eligible patients received 4 intravenous doses of TXA: Ineligible patients received no TXA. Patients with medical conditions precluding the use of TXA were deemed ineligible: allergy to TXA; creatinine clearance <30 mL/min; active malignancy; vascular event in the past year; anticoagulant use; fracture >48 hours prior to presentation. A subset of patients received only admission TXA dosing and a separate subset of patients received only incision and post op TXA dosing. Red blood cell transfusions, major adverse vascular events, and minor drug and infusion-related adverse events were recorded for all subgroups of patients. Results A total of 508 patients were eligible for analysis. In total, 180 patients received no TXA, 32 patients only received the admission doses of TXA, 112 patients received only the arthroplasty based (incision and post op) doses of TXA, and 183 patients received all 4 doses of TXA. The transfusion rate was significantly lower in patients who received all 4 doses of TXA (8.7%) and in those who only received one dose of TXA at admission (9.4%) compared to patients who received TXA at incision and recovery room (25.7%) or those patients who did not receive TXA prophylaxis (29.4%) (P = 0.001). Additionally, the transfusion rate for intramedullary nailing was higher compared to patients undergoing any other procedure (27% vs 13.8%, P < 0.001). Conclusions Patients with fragility hip fractures who received IV TXA at hospital admission have significantly lower transfusion rates compared to those who received no tranexamic acid or those who received two dose-TXA (at the operative incision and in the post-operative recovery room). These findings suggest that isolated dosing of TXA at hospital admission may be more effective at reducing post-operative bleeding than the traditional arthroplasty dosing (incision and post-op doses) and is equally as effective as the 4-dose TXA protocol in hip fracture patients undergoing surgery.

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Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures

Cited by 9 publications

References 39 publications

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

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

Intraoperative Dysrhythmias Cease After Venting During Intramedullary Nailing of an Impending Femur Fracture

Tranexamic Acid Administration at Hospital Admission Decreases Transfusion Rates in Geriatric Hip Fracture Patients Undergoing Surgery

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