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European Journal of Orthopaedic Surgery & Traumatology

Open Access 21-05-2024 | Original Article

Complications and survival rates of subtrochanteric fractures are similar between short and long intramedullary nail fixation and independent of weight-bearing

Authors: Daniel Cohen, Yaakov Tolwin, Michael Toybenshlak, Gershon Zinger, Amos Peyser, Yadin Levy

Published in: European Journal of Orthopaedic Surgery & Traumatology

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Abstract

Purpose

Intertrochanteric fractures are treated surgically, allowing rapid weight-bearing to improve ambulation and lower complications and mortality. Subtrochanteric fractures are mechanically less stable and are traditionally treated with a non-weight approach and longer intramedullary nails. This study compared immediate weight-bearing versus limited weight-bearing and different intramedullary nail lengths regarding patient outcomes.

Methods

We analyzed all consecutive cases of low-energy subtrochanteric fractures treated surgically at our institution between January 2016 and November 2020. One hundred and nine patients were found. We compared nail length and immediate versus delayed weight-bearing concerning the length of stay, time to painless ambulation, time to radiographic fracture union, and revision rates. Fracture severity was also examined using the Seinsheimer classification.

Results

Length of stay and time to painless ambulation were shorter in the immediate weight-bearing group. Time to radiographic union and rate of complications were lower; however, they were not statistically significant. Conversely, no significant difference in revision rates was found. Regarding nail length, the length of stay was shorter, and the time to painless ambulation was faster in the short-length group. The rate of complications and time to union were similar. No difference in revision rate was found. Seinsheimer classification of the fracture did not influence the decision to allow weight-bearing or nail selection (p = 0.65).

Conclusions

This study demonstrates that immediate weight-bearing as tolerated and short intramedullary nails allow a quicker time for painless ambulation and hospitalization, with possibly fewer perioperative complications and faster radiographic union, without increasing complications.
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Metadata
Title
Complications and survival rates of subtrochanteric fractures are similar between short and long intramedullary nail fixation and independent of weight-bearing
Authors
Daniel Cohen
Yaakov Tolwin
Michael Toybenshlak
Gershon Zinger
Amos Peyser
Yadin Levy
Publication date
21-05-2024
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-03992-w