Treating Intertrochanteric Fracture by Short and Long Cephalomedullary Nail: A Systematic Review and Meta-analysis

Intertrochanteric femur fracture is a common injury, and cephalomedullary nailing has become a popular surgical technique for the treatment of these types of fracture patterns. Various nail implant designs exist, including both short and long versions. The initial design of the implant was a short cephalomedullary nail, but it was associated with problems such as increased hip pain and periprosthetic fracture. To address these issues, a longer nail was developed. In this review, we determine the advantage of treating the intertrochanteric fracture using long and short intramedullary nails. We also compared the outcomes among the different types of nail manufacturers. All trials comparing long and short nails were included. We searched Google Scholar, PubMed, central Cochrane, Clinic Trials and Science Direct. Two authors screened and reviewed studies independently and collected data using fixed-effect models. The results were presented as risk ratio (RR) and mean difference (MD) at 95% confidence intervals (CI). Twenty trials were included with a total of 3470 patients. The results showed that the short nail group had a shorter operative time, less blood loss and hip pain, lower transfusion and peri-implant fracture rate. Functional outcomes were favourable for both nail types, though scores were slightly better in the long nail group. There was no significant difference in mortality, complication rates, or reoperation rates between the two groups.