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Trochanteric hip fractures with subtrochanteric extension. Does the cephalomedullary nail length matter?
Garcia-Barrerio Gonzalo1, Colom Juan2, Lucena Macarena2
1Orthopaedic Surgery Department, Italian Hospital of Buenos Aires, CABA, Potosi 4247, C1199ABB, Buenos Aires, Argentina. gonzalog.garcia@hospitalitaliano.org.ar.
Introduction:
Short or standard nails are widely accepted as the treatment of choice for unstable intertrochanteric fractures, while long nails are preferred for the treatment of subtrochanteric fractures. There is no consensus on the optimal implant length for peri/intertrochanteric fractures with subtrochanteric extension. Determining whether to opt for a standard or a long intramedullary nail (IMN) is often unclear and tends to be subjective. The aim of this study was to compare functional outcomes before and 1 year after the surgical fixation of trochanteric fractures with subtrochanteric extension, reoperation rates, 1-year mortality rates, surgical time, blood loss, quality of fracture reduction, and tip-apex distance (TAD) in patients treated with either standard or long cephalomedullary nails.
Materials And Methods:
A retrospective cohort study was conducted using our Institutional Fragility Hip Fracture Registry. All patients over 65 years old who underwent hip surgery due to an intertrochanteric fracture with subtrochanteric extension > 2 cm from the lesser trochanter between January 1, 2015, and December 31, 2021, were included. Patients were divided based on the length of the cephalomedullary nails used to treat the trochanteric fractures (standard vs. long nails).
Results:
Competing risk analyses showed significant differences in the subdistribution hazard ratio (SHR) for PMS reduction in the unadjusted SHR = 0.37 (95% CI 0.15, 0.88) and adjusted SHR = 0.4 (95% CI 0.17, 0.94) in favor of the long nail group. No differences were detected in 1-year mortality rates, which were 16.29%. There were also no differences in TAD, reoperations, quality of reduction, or blood loss, although surgical time was longer for the long nail group.
Conclusion:
Of 1533 peri-intertrochanteric fractures, 11.6% exhibited subtrochanteric extension of more than 2 cm. While long nails demonstrated advantages in PMS reduction and fracture extension management, standard nails had the advantage of reducing surgical time. Both standard and long nails exhibited comparable outcomes in terms of mortality, surgical complications, and hematological parameters.
