Thurs., 10/4/12 Hip Fractures, PAPER #30, 3:43 pm OTA-2012
Treatment of Pertrochanteric Fractures (AO/OTA 31-A1 and A2): Long Versus Short Cephalomedullary Nailing
Kaan S. Irgit, MD; Zhiyong Hou, MD; Thomas R. Bowen, MD; Michelle E. Matzko, PhD;
Cassondra M. Andreychik, BA; Daniel S. Horwitz, MD; Wade R. Smith, MD;
Geisinger Medical Center, Department of Orthopaedic Surgery, Danville, Pennsylvania USA
Background/Hypothesis: We hypothesized that there is no clinical difference in outcomes between elderly patients with low-energy, simple, or multifragmentary pertrochanteric femur fractures without subtrochanteric extension (AO/OTA 31-A1 and A2) treated with a long versus short cephalomedullary nail.
Methods: The records of 409 patients presenting to a Level I trauma center between 2004 and 2009 with pertrochanteric fractures without subtrochanteric extension (AO/OTA 31-A1 and A2) were retrospectively reviewed. Patients treated with implants other than either a long or short cephalomedullary nail were excluded from the study. Patient demographics, treatment-related variables, and clinical and radiographic outcomes were recorded for each patient. χ2, analysis of variance, or nonparametric tests were used to compare patients treated with either a short or long cephalomedullary nail.
Results: 283 patients qualified for inclusion in this study (average age, 79 years [range, 53-102]); 100 patients were treated with a short nail (170 mm) and 183 with a long nail. All patients were treated with a single nail design having identical proximal fixation. The choice of long versus short nail was based on surgeon preferences. Excluding those who died in the perioperative period, the average postoperative follow-up was 37 ± 2.3 months (range, 12-58 months). There was no significant difference in postoperative mortality rates between the two groups. There was no clinically significant difference in outcomes between patients treated with long nails compared to those treated with short nails. Patients treated with short nails had, on average, shorter operative times (41 vs 61 minutes, P <0.0001) and decreased blood loss (100 mL vs135 mL, P = 0.031). Implant-related complications and number of reoperations did not differ between groups. No postoperative fractures occurred distal to the short nail. There were two late, postoperative fractures occurring in two patients at the distal end of long nails.
Conclusion: Long nails offer no clinical advantage compared to short nails. The increased cost of the long nail (~$500 more) and the greater operative time compared to short nails may not justify the use of a long nail in the treatment of simple and multifragmentary pertrochanteric femur fractures (AO/OTA 31-A1 and A2) in the elderly. Long nails do not appear to prevent fractures distal to the implant.
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• 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.