Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study : Journal of Orthopaedic Trauma

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Original Article

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

Shannon, Steven F. MD; Yuan, Brandon J. MD; Cross, William W. III MD; Barlow, Jonathan D. MD; Torchia, Michael E. MD; Holte, Pamela K. CNP; Sems, Stephen A. MD

Author Information
Journal of Orthopaedic Trauma 33(10):p 480-486, October 2019. | DOI: 10.1097/BOT.0000000000001553



To compare functional and clinical outcomes in patients with pertrochanteric hip fractures treated with either a short (SN) or long (LN) cephalomedullary nail.


Prospective, randomized.


Clinical investigation was performed at the Mayo Clinic's Level 1 Trauma Center in Rochester, MN.


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.


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.


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.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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