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

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

doi:10.3892/etm.2021.11029

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

Authors:
- Șerban Dragosloveanu
- Christiana D.M. Dragosloveanu
- Dragoș C. Cotor
- Cristian I. Stoica
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Affiliations: Department of Orthopedics, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania, Department of Ophthalmology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania, Department of Orthopedic Surgery, ‘Foişor’ Orthopedics‑Traumatology and Osteoarticular TB Hospital, 030167 Bucharest, Romania
Published online on: December 1, 2021 https://doi.org/10.3892/etm.2021.11029
Article Number: 106

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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.

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