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Short Versus Long Cephalomedullary Nails for the Treatment of Intertrochanteric Hip Fractures in Patients Older than 65 Years

Kleweno, Conor MD*; Morgan, Jordan BS*; Redshaw, James BS; Harris, Mitchel MD; Rodriguez, Edward MD, PhD; Zurakowski, David PhD§; Vrahas, Mark MD*; Appleton, Paul MD

Journal of Orthopaedic Trauma: July 2014 - Volume 28 - Issue 7 - p 391–397
doi: 10.1097/BOT.0000000000000036
Original Article

Objectives: To compare failure rates between short and long cephalomedullary nails used for the treatment of intertrochanteric hip fractures in patients over 65 years of age.

Design: Retrospective cohort study. Data were collected from medical records and radiographs.

Setting: Three level 1 trauma centers.

Patients/Participants: Patients aged 65 years or older who underwent treatment of an intertrochanteric hip fracture with a cephalomedullary nail between January 2004 and December 2010.

Intervention: Open reduction and internal fixation of intertrochanteric hip fracture with either short or long cephalomedullary nail.

Main Outcome Measurement: Postoperative treatment failure rate, defined as periprosthetic fracture or reoperation requiring removal or revision of nail, including conversion to arthroplasty.

Results: Incidence of treatment failure (periprosthetic fracture and reoperation requiring removal of nail) was 30 of 559 (5.4%) for the entire cohort; 13 of 219 (5.9%) occurred after placement of a short nail compared with 17 of 340 (5.0%) after placement of a long nail (P = 0.70). There were 11 of 559 (2.0%) patients who sustained a periprosthetic fracture after nailing, 6 of 219 (2.7%) after short nails and 5 of 340 (1.5%) after long nails (P = 0.35). The remaining 19 treatment failures were major reoperations requiring removal of nail, 7 of 219 (3.2%) after short nails and 12 of 340 (3.5%) after long nails (P = 0.81). The reasons for these 19 revision procedures were: screw/helical blade cutout (16), progressive arthritis with conversion to arthroplasty (1), avascular necrosis of femoral head with conversion to arthroplasty (1), and symptomatic leg length discrepancy with conversion to arthroplasty (1). Median follow-up period for patients living at least 1 year postoperatively was 30 months (range, 12–85 months). Overall, 175 of 698 (25%) patients died within 1 year after index surgery.

Conclusions: When using contemporary cephalomedullary implants, short and long nails exhibit similar treatment failure rates.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA;

Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;

Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and

§Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Reprints: Conor Kleweno, MD, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Center, Suite 3C, Boston, MA 02114 (e-mail: conorkleweno@gmail.com).

The authors report no conflict of interest.

This study was reviewed and approved by the Beth Israel Deaconess Medical Center IRB.

Accepted October 31, 2013

© 2014 by Lippincott Williams & Wilkins