Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

Șerban Dragosloveanu; Christiana D M Dragosloveanu; Dragoș C Cotor; Cristian I Stoica

doi:10.3892/etm.2021.11029

Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study

Exp Ther Med. 2022 Jan;23(1):106. doi: 10.3892/etm.2021.11029. Epub 2021 Dec 1.

Authors

Șerban Dragosloveanu^{1

2}, Christiana D M Dragosloveanu³, Dragoș C Cotor², Cristian I Stoica^{1

2}

Affiliations

¹ Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.
² Department of Orthopedic Surgery, 'Foişor' Orthopedics-Traumatology and Osteoarticular TB Hospital, 030167 Bucharest, Romania.
³ Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.

Abstract

In unstable pertrochanteric fractures, there are still debates regarding the complications and long-term benefits after internal fixation using short or long cephalomedullary nails. Therefore, a study was developed regarding this idea. From May 2017 to April 2020, 61 patients with unstable (AO 31-A2) and intertrochanteric fractures (AO 31-A3) were surgically operated on. During follow-up, 8 patients were excluded (lost or deceased). A total of 26 patients received internal short nail system fixation and 27 received a long nail system. All cases followed the standard 6-week rehabilitation protocol. Follow-up was at 3, 6 weeks, 3, 6 and 12 months, and clinical and functional assessment were determined by a different surgeon using the Visual Analogue Scale (VAS), Harris Hip Score (HHS) and Functional Ambulation Categories (FAC). A total of 42 (79.2%) had a 31.A2 fracture (21 in the long nail group and 21 in the short nail group) and 11 (20.8%) had a 31.A3 fracture (6 in long nail group and 5 in the short nail group). Surgical time was significantly longer (P<0.05) in the long nail group (an average of 81.38±12.01 min), compared with the short nail group (53.11±8.36 min). Blood loss was significantly higher (P<0.05) in the long nail group (210±12.1 ml) compared to the short nail group (75.4±14.8 ml). No statistical differences were noted regarding tip-apex distance (TAD) and VAS score. At 6 months, HHS was better for the short nail group (84.76±3.68) (P<0.05). Regarding the FAC scale, no significant statistical differences were identified. Cut-out occurred in 2 cases in the short nail group and 1 case from the long nail group. Only 1 peri-implant fracture occurred in a patient with a long cephalomedullary nail. In conclusion, the long cephalomedullary nail requires a longer surgical time and is associated with an increase in intraoperative blood loss without improving the functional outcome after 12 months postoperatively. A larger sample of cases is required to thoroughly analyze the postoperative complications.

Keywords: hip; implant choice; long intramedullary nail systems; short intramedullary nail systems; trochanteric fractures.

Grants and funding

Funding: No funding was received.