Does Size Matter for Cephalomedullary Nails in Geriatric Intertrochanteric Fractures?

Abstract

Objectives: To evaluate the need for reoperation of geriatric intertrochanteric hip fractures treated with 10-mm cephalomedullary nails versus those treated with nails larger than 10 mm. Design:Retrospective review at a single institution.Setting: Level I trauma center.Patients/Participants: All patients age 60 and over treated with cephalomedullary fixation for an intertrochanteric femur fracture at a single institution.Intervention: Cephalomedullary fixation with variable nail diameters.Main Outcome Measurements: Reoperation rates of geriatric intertrochanteric fractures treated with a size 10-mm diameter cephalomedullary nail compared with patients treated with nails larger than 10 mm.Results: There were no significant differences in reoperation rates when the 10-mm cohort was compared with an aggregate cohort of all nails larger than 10 mm (P = 0.99). This result was true for both allcause reoperation and noninfectious reoperation. There was no difference between cohorts in regards to age, gender, or fracture pattern.Conclusions: A 10-mm cephalomedullary nail can be used in lieu of a larger diameter fixation in patients age 60 and older with intertrochanteric femur fractures while still maintaining a comparable rate of reoperation.

Does matching degree matter for proximal femoral intramedullary nail on reoperation rate in intertrochanteric fractures?

“…The reduction quality of OTA/AO 31A3 fractures tended to be identi ed as "poor." Six cases (30%) of OTA/AO 31A3 fractures required second surgery, and this reoperation rate was higher than in other studies [15]. OTA/AO 31A3 fractures lead to a high rate of internal xation failure due to di culty in reduction.…”

“…More clinical analyses are needed to de ne the effect of the nail-canal gap on fracture healing. Subsequent clinical studies assessed the reoperation rate of proximal femoral intramedullary nails with diameters of 10 and > 10 mm in the treatment of intertrochanteric fractures and found no signi cant difference between the two groups (P > 0.05) [15]; however, this study did not take into account the effect of individual differences in femoral marrow cavity. The matching degree of the nail depends on the difference or ratio of the diameter of the femoral marrow cavity and that of the intramedullary nail.…”

“…Although nailing with small-and large-diameter intramedullary nails had similar rates of fracture healing and secondary fracture [15], small-diameter intramedullary nails tended to be used to decrease the incidence of anterior cortical impingement [24,26]; one scholar indicated that large-diameter nails would not bring more bene ts to patients. Large-diameter nails relatively narrow the nail-canal gap, and the nail tip is more likely to 'hit' the anterior femoral cortex and lead to perforated fractures [24].…”

“…Fractures were classi ed according to OTA/AO classi cation [14]. OTA/AO 31A1 fractures were de ned as stable fractures, and 31A2 and 31A3 fractures were de ned as unstable fractures [15]. According to the experience of Baumgaertner et al, the standard reduction was de ned as follows.…”

Trauma

“…A similar question arises for intertrochanteric fractures treated with cephalomedullary nails, and is the subject of a recent study from a group in Dallas (Texas, USA). 6 The authors included patients with intertrochanteric fractures over the age of 60 years in their observational cohort study. This particular paper compared 10 mm nails and an aggregate group of any nail larger than 10 mm, with the aim of establishing if there were any apparent differences.…”