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Complications of standard versus long cephalomedullary nails in the treatment of unstable extracapsular proximal femoral fractures: A randomized controlled trial

  • David Martí-Garín
    Affiliations
    Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES

    Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES

    Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
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  • Ferran Fillat-Gomà
    Affiliations
    Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES

    Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES

    Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
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  • Francesc Antoni Marcano-Fernández
    Affiliations
    Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES

    Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES

    Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
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  • Mariano Balaguer-Castro
    Affiliations
    Hospital Clínic de Barcelona, Orthopaedic Department, Barcelona, Catalunya, ES
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  • Juan Murias Álvarez
    Affiliations
    Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES

    Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES

    Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
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  • Raul Pellejero
    Affiliations
    Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES

    Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES

    Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
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  • Joël Sánchez Fernández
    Affiliations
    Consorci Corporació Sanitària Parc Taulí, Department of Orthopaedic Surgery and Traumatology, Sabadell, Catalunya, ES

    Institut d'Investigació i Innovació Parc Tauli, Sabadell, Catalunya, ES

    Universitat Autònoma de Barcelona, Barcelona, Catalunya, ES
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  • Pere Torner
    Affiliations
    Hospital Clínic de Barcelona, Orthopaedic Department, Barcelona, Catalunya, ES
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  • Josep Maria Muñoz Vives
    Correspondence
    Corresponding author.
    Affiliations
    Fundació Althaia de Manresa, Orthopaedic Surgery, Manresa, Barcelona, ES
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Published:November 14, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.037

      Abstract

      Aims

      To compare in a prospective randomized trial the mechanical complications in patients with unstable extracapsular proximal femur fractures without subtrochanteric extension (AO/OTA 31-A2 and 31-A3)

      Methods

      We prospectively studied 182 patients with unstable extracapsular proximal femur fractures without fractures lines extending more than 3 cm below the lesser trochanter, randomized to receive either a ‘standard’ (240 mm) nail or a long nail and followed them up for 1 year.

      Results

      We found no difference in the incidence of mechanical or general complications between the two groups, no cut-outs, no fractures of the tip the implant, 1 cut-through and 2 malrotations in the LN group, 2 non-unions that were reoperated, one on each group. The commonest complication was blade lateral migration, 13 (14%) patients in SN and 6 (9%) in the LN. The operating time was shorter in the SN group 51 minutes compared to 67 minutes in the LN group (p=0.000075). The mortality at 1,3 and 12 months in the SN group was of 2%, 6%, 12% while in the LN group was 12%, 18% and 22%. These differences where significative at 1 (p=0.007) and 3 months (p=0.013), but not at 12 months (p=0.075).

      Conclusions

      We recommend the use of standard nails (240 mm) for this group of fractures, since it does not produce more mechanical complications, and it is faster, cheaper and easier to interlock distally.

      Keywords

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      References

        • Anglen JO
        • Weinstein JN.
        Nail or plate fixation of intertrochanteric hip fractures: Changing pattern of practice - A review of the American Board of Orthopaedic Surgery database.
        J Bone Jt Surg - Ser A. 2008; 90: 700-707
        • Bridle SH
        • Patel AD
        • Bircher M
        • Calvert PT.
        Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the Gamma nail and the dynamic hip screw.
        J Bone Jt Surg - Ser B. 1991; 73: 330-334
        • Parker MJ
        • Handoll HH.
        Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults.
        Cochrane Database Syst Rev. 2010; CD000093
        • Radford PJ
        • Needoff M
        • Webb JK.
        A prospective randomised comparison of the dynamic hip screw and the gamma locking nail.
        J Bone Joint Surg Br. 1993; 75: 789-793
        • Page PRJ
        • Poole WEC
        • Shah K
        • Upadhyay PK.
        Short or long intramedullary devices for hip fracture? A systematic review of the evidence.
        J Orthop. 2020; 22: 377-382
        • Horwitz DS
        • Tawari A
        • Suk M.
        Nail length in the management of intertrochanteric fracture of the femur.
        J Am Acad Orthop Surg. 2016; 24: e50-e58
        • Socci AR
        • Casemyr NE
        • Leslie MP
        • Baumgaertner MR.
        Implant options for the treatment of intertrochanteric fractures of the hip rationale, evidence, and recommendations.
        Bone Jt J. 2017; 99-B: 128-133
        • Okcu G
        • Ozkayin N
        • Okta C
        • Topcu I
        • Aktuglu K.
        Which implant is better for treating reverse obliquity fractures of the proximal femur: A standard or long nail?.
        Clin Orthop. 2013; 471: 2768-2775
        • Galanopoulos IP
        • Mavrogenis AF
        • Megaloikonomos PD
        • Vottis CT
        • Mitsiokapa E
        • Koulouvaris P
        • et al.
        Similar function and complications for patients with short versus long hip nailing for unstable pertrochanteric fractures.
        SICOT-J. 2018; 4: 23
        • Shannon SF
        • Yuan BJ
        • Cross WW
        • Barlow JD
        • Torchia ME
        • Holte PK
        • et al.
        Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study.
        J Orthop Trauma. 2019; 33: 480-486
        • Șerban Dragosloveanu
        • Dragosloveanu C
        • Cotor D
        • Stoica C.
        Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study.
        Exp Ther Med. 2021; 23: 106
        • Parker MJ.
        Cutting-out of the dynamic hip screw related to its position.
        J Bone Joint Surg Br. 1992; 74: 625
        • Frei HC
        • Hotz T
        • Cadosch D
        • Rudin M
        • Käch K.
        Central Head Perforation, or “Cut Through,” Caused by the Helical Blade of the Proximal Femoral Nail Antirotation.
        J Orthop Trauma. 2012; 26: e102-e107
        • Baumgaertner MR
        • Curtin SL
        • Lindskog DM
        • Keggi JM.
        The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip.
        J Bone Jt Surg. 1995; 77: 1058-1064
        • Marsh JL
        • Slongo TF
        • Agel J
        • Broderick JS
        • Creevey W
        • DeCoster TA
        • et al.
        Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.
        J Orthop Trauma. 2007; 21: S1-133
        • Hou Z
        • Bowen TR
        • Irgit KS
        • Matzko ME
        • Andreychik CM
        • Horwitz DS
        • et al.
        Treatment of Pertrochanteric Fractures (OTA 31-A1 and A2): Long Versus Short Cephalomedullary Nailing.
        J Orthop Trauma. 2013; 27: 7
        • Valverde JA
        • Alonso MG
        • Porro JG
        • Rueda D
        • Larrauri PM
        • Soler JJ.
        Use of the Gamma nail in the treatment of fractures of the proximal femur.
        Clin Orthop. 1998; 17: 56-61
        • Parker MJ
        • Short Cawley S.
        (175 mm) versus standard (220 mm) length intramedullary nail for trochanteric hip fractures: a randomized trial of 229 patients.
        Bone Jt J. 2020; 102-B: 394-399
        • Okcu G
        • Ozkayin N
        • Okta C
        • Topcu I
        • Aktuglu K.
        Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?.
        Clin Orthop. 2013; 471: 2768-2775
        • Schipper IB
        • Steyerberg EW
        • Castelein RM
        • van der Heijden FHWM
        • den Hoed PT
        • Kerver AJH
        • et al.
        Treatment of unstable trochanteric fractures: randomised comparison of the gamma nail and the proximal femoral nail.
        J Bone Joint Surg Br. 2004; 86-B: 86-94
        • Bhandari M
        • Schemitsch E
        • Jönsson A
        • Zlowodzki M
        • Haidukewych GJ.
        Gamma Nails Revisited: Gamma Nails Versus Compression Hip Screws in the Management of Intertrochanteric Fractures of the Hip: A Meta-Analysis.
        J Orthop Trauma. 2009; 23: 460-464
        • Frisch NB
        • Nahm NJ
        • Khalil JG
        • Les CM
        • Guthrie ST
        • Charters MA.
        Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fracture.
        Orthopedics. 2017; 40: 83-88
        • Raval P
        • Ramasamy A
        • Raza H
        • Khan K
        • Awan N.
        Comparison of short vs long anti-rotation in treating trochanteric fractures.
        Malays Orthop J. 2016; 10: 22-28