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Intramedullary nailing of subtrochanteric fractures in elderly patients: Comparative study of helical blade cephalomedullary nail versus reconstruction nail

Published:January 24, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.038

      Highlights

      • Internal fixation with intramedullary nails is a common method for the treatment of subtrochanteric fracture.
      • To our knowledge, no study has compared and analyzed the clinical and radiologic outcomes of these nails in elderly patients aged ≥65 years.
      • A prospective case-matched study was done on patients ≥ 65 years with femoral subtrochanteric fracture and underwent intramedullary nailing.
      • Differences in all results were not statistically significant; however, the RCN group tended better reduction quality than the CMN group.
      • RCN has outstanding reduction quality, strong fixation, and excellent clinical/radiologic outcomes for femoral subtrochanteric fractures.

      Abstract

      Introduction

      Intramedullary nailing (IMN), which is a common method for treating subtrochanteric fractures, is conducted as cephalomedullary (CMN) or reconstruction (RCN) nailing. Numerous studies have reported the effectiveness of CMN, which requires a shorter surgery time and provides stronger fixation strength with blade-type devices. However, the radiographic and clinical outcomes of the use of CMN and RCN in elderly patients aged ≥65 years have not been compared yet. This study aimed to investigate whether CMN offers superior outcomes over RCN in the treatment of subtrochanteric fractures in elderly patients.

      Materials and methods

      This retrospective study included 60 elderly patients (17 men and 43 women; mean age: 74.9 years) diagnosed with subtrochanteric fractures and treated with IMN with helical blade CMN (CMN group: 30 patients) or RCN (RCN group: 30 patients) between January 2013 and December 2018 with at least 1 year of follow-up period. Radiologic outcomes were evaluated based on the postoperative state of alignment and the achievement and timing of bony union at the final follow-up. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score. Radiologic and clinical outcomes in the two groups were compared and analyzed, and the occurrence of complications was examined.

      Results

      The difference in malalignment between the two groups was not significant; however, the RCN group achieved more effective reduction. At the final follow-up, bony union was achieved within 18.9 weeks, on average, in 28 patients in the CMN group and within 21.6 weeks, on average, in 27 patients in the RCN group. Twenty patients in the CMN group and 26 in the RCN group showed good or better results according to the Merle d'Aubigné–Postel score. No significant differences were found for any of the parameters.

      Conclusions

      In the treatment of difficult subtrochanteric fractures in elderly patients, RCN can provide excellent reduction and strong fixation similar to CMN and can result in outstanding clinical and radiologic outcomes.

      Keywords

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