Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study

Abstract

Objective: To compare functional and clinical outcomes in patients with pertrochanteric hip fractures treated with either a short (SN) or long (LN) cephalomedullary nail. Design: Prospective, randomized. Setting: Clinical investigation was performed at the Mayo Clinic's Level 1 Trauma Center in Rochester, MN. Patients/Participants: Two hundred twenty patients with intertrochanteric fractures were prospectively randomized to an SN or LN cohort. A total of 168 patients (SN, n = 80; LN, n = 88) had a mean follow-up of 13.9 months. Fifty-two patients did not meet the minimum 3-month follow-up. Demographics were comparable between the cohorts. Main Outcome Measures: The primary outcome measurement was functional outcome evaluated by Short Form (SF-36) and Harris Hip scores (HHS) at 3 months. Secondary outcomes included implant failure, peri-implant fracture, mortality, operative time, estimated blood loss, and reoperation. Results: SN and LN cohorts were comparable in all aspects of the SF-36. There was a clinically insignificant difference in the HHS between cohorts. Patients treated in the SN cohort experienced shorter operative times but did not differ in tip-to-apex distance or subtrochanteric fracture extension. There was no difference in implant cutout, deep surgical site infection, or peri-implant fractures. Conclusions: Patients treated with SNs or LNs for pertrochanteric femur fractures experienced comparable functional outcomes as measured by SF-36 and HHS. When compared with the LN cohort, SN patients experienced no difference in peri-implant fracture or lag-screw cutout and tolerated up to 3 cm of subtrochanteric fracture line extension. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Short or long intramedullary devices for hip fracture? A systematic review of the evidence

“…Shannon et al used the SF-36 instrument, with a power calculation predicated on the minimum clinically important difference for total knee replacement and tibial plateau fracture fixation. [21][22][23] This study also excluded patients with dementia on the basis of inability to complete the PROM, thereby substantially reducing the generalizability of the findings to a population with a high burden of cognitive impairment. It has been demonstrated that the EuroQol 5-dimension instrument (EQ-5D) can be effectively completed by carers or relatives with a high degree of reliability and, given that its effect size in hip fracture is relatively well-understood and it already forms part of the core outcome set in the United Kingdom for hip fracture research, it would represent a much more appropriate choice of PROM.…”

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

“…and Shannon et al . , had a randomised controlled trail (RCT) design 27 , 28 , 33 . The remaining thirteen studies were retrospective cohort studies.…”

“…Twelve studies included data on operative times for the surgical procedures. All but one study reporting a significantly longer operating time for long CMDs as compared to short CMDs, with Hong being the only dissenting study 18 , 22 – 31 , 33 .…”

Characteristics of intramedullary nail breakage in pertrochanteric femur fractures: a summary of 70 cases

“…Compared with cut-out, a common form of implant failure mostly occurs within 3 months postoperatively [ 25 ], IM nail breakage has a relatively late average occurrence time, but lacks of time regularity (Table 3 ; Fig. 3 ).…”