OTA 2013 Posters

Scientific Poster #34 Geriatric OTA 2013

Retrospective Comparison of Short Versus Long Cephalomedullary Nails for the Treatment of Unstable Intertrochanteric Fractures

Michael Charters, MD, MS; Nicholas Frisch, MD, MBA; Wael Ghacham, MD;
Christopher Dobson, BS; Jad Khalil, MD; Joseph Hoegler, MD; Stuart T. Guthrie, MD;
William Hakeos, MD; Clifford Les, DVM, PhD;
Henry Ford Hospital, Detroit, Michigan, USA

Purpose: The purpose of this study was to compare perioperative measures and postoperative orthopaedic complications between patients who underwent short and long cephalomedullary nails for the treatment of unstable intertrochanteric fractures. Perioperative measures studied included surgical time, estimated blood loss (EBL), and fluoroscopy time. Postoperative orthopaedic complications studied included infection, screw cut-out, periprosthetic femur fracture, and hardware failure.

Methods: The clinical and radiographic records of 505 consecutive patients presenting with intertrochanteric fractures between 2006 and 2010 were reviewed retrospectively. Patients were included if they had an unstable intertrochanteric fracture treated with cephalomedullary nail. Patients were excluded if they had subtrochanteric fracture or if they had inadequate follow-up. The Wilcoxon two-sample test was used to compare perioperative measures and the χ2 test was used to compare postoperative orthopaedic complications between patients who underwent short and long cephalomedullary nails for the treatment of unstable intertrochanteric fractures.

Results: 310 patients were treated with linear compression cephalomedullary nails during the study period and 206 patients had adequate follow-up for inclusion in the study. Mean radiographic follow-up was 5 months. 88 patients (42.7%) were treated with short nail and 118 patients (57.3%) were treated with long nail during the study period. Demographics were similar between the two groups. Surgical time was shorter in the short nail group (66.9 vs 83.6 minutes, P = 0.001). Fluoroscopy time was shorter in the short nail group (106.1 vs 141.4 seconds, P = 0.001). EBL was less in the short nail group (176.4 vs 214.1 mL, P = 0.042). Infection rate was similar between the two groups. There was one implant failure in the short group and one implant failure in the long group (P = 0.999). There were six screw cut-outs in the long nail group (5.1%) and none in the short group (P = 0.039). There were seven periprosthetic femur fractures (8.0%) in the short nail group and none in the long group (P = 0.002).

Conclusion: This study demonstrates a similar overall rate of orthopaedic complications between short and long cephalomedullary nails for the treatment of unstable intertrochanteric fracture. These results confirm the suspected advantages of short cephalomedullary nails including faster surgery, less blood loss, and less radiation exposure. There were no screw cut-outs in the short nail group and there were no femur fractures in the long nail group. There were more femoral shaft fractures in short nails, and this remains high despite implant design changes. The higher screw cut-out rate in long nails may be from increased rigidity of the construct distally being transferred proximally.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.