Femur Fractures Distal to Long and Short Cephalomedullary Nails: A Comparative Multicenter Study.

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Cephalomedullary nails (CMNs) are standard for intertrochanteric hip fractures.
• Fractures distal to CMNs present management challenges, with outcomes varying by nail length.
• Optimal treatment strategies for these distal fractures remain unclear.

Purpose of the Study:

• To compare treatment strategies and outcomes for fractures distal to short versus long CMNs.
• To evaluate the effectiveness of different surgical revisions for these specific fractures.

Main Methods:

• A multicenter retrospective study of 58 patients with fractures distal to short (n=30) or long (n=28) CMNs.
• Comparison of demographics, injury characteristics, and perioperative outcomes.
• Multivariable linear regression to compare exchange CMN versus ORIF outcomes.

Main Results:

• Fractures below short CMNs often managed with exchange CMN or nail-plate; those below long CMNs typically treated with ORIF.
• No significant differences in surgical time, blood loss, fluoroscopy use, transfusion rates, length of stay, or postoperative complications between short and long CMN cohorts.
• Exchange CMN, compared to ORIF, showed similar complication/transfusion rates but significantly improved odds of earlier weight-bearing and discharge home.

Conclusions:

• This study represents the largest series of fractures distal to CMNs.
• Surgical morbidity, time, and fluoroscopy use are comparable for short and long CMNs.
• Exchange CMN offers functional benefits over ORIF for distal CMN fractures, including earlier weight-bearing and discharge.