3-year revision rates of left vs right cephalomedullary nails with a helical blade design

Intramedullary (IM) femoral nailing in the form of cephalomedullary (CM) nailing is a common treatment of intertrochanteric femoral fractures. Previous literature has demonstrated higher revision rates of left intertrochanteric fractures. Helical blade constructs offer a theoretical advantage over a screw design.

The objective of this study is to examine 3 year revision rates for right vs left CM nails with helical blade head screw. No current studies exist which compare revision rates in left versus right IM nails over this defined time period.

Patients who sustained intertrochanteric femoral fracture subsequently treated by CM nailing between July 2021 and December 2022 were retrospectively identified from a database of orthopaedic patients. Patients were stratified based on left-sided or right-sided fracture. Criteria for inclusion were anterograde femoral nails, performed for Intertrochanteric hip fractures. Exclusion criteria included revision nails, retrograde nails, diaphyseal and subtrochanteric fractures, reverse oblique fracture patterns and prophylactic nails. The primary outcome was 3 year revision rate. Relevant frequency statistics were generated for each cohort with odds ratios comparing revision rates between the two groups.

n = 104 patients were included in the final sample, comprising n = 48 left and n = 56 right sided intertrochanteric fractures who underwent CM nailing. n = 4 (3.8%) TFNAs underwent subsequent surgical revision. Incidence of revision was higher in patients undergoing left IM nailing Left: 3/48, 0.063, Right: 1/56, 0.018, Odds Ratio: 3.667, 95% Confidence Interval: 0.37 - 36.47, p = 0.268).

A greater proportion of patients who sustained a left sided intertrochanteric fracture and were surgically treated with CM nailing underwent revision surgery within 3 years of initial surgery compared to right sided CM nails.