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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2016 | Original Article

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Authors: John Dunn, Nicholas Kusnezov, Julia Bader, Brian R. Waterman, Justin Orr, Philip J. Belmont

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2016

Abstract

Background

Both long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures.

Materials and methods

A literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay.

Results

Included in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P < 0.0001). No significant differences between short and long nails were observed for either other complications, hardware complications, non-union, or mortality.

Conclusions

For trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective.

Level of evidence

Level 3.

Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 2(6):285–289CrossRef

Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U (2012) Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 380(9838):247–257CrossRefPubMed

Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M (1996) Epidemiology of hip fractures. Bone 18(1):57S–63SCrossRefPubMed

Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–1579CrossRefPubMedPubMedCentral

Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a review and meta-analysis. Injury 43(6):676–685CrossRefPubMed

Barton TM, Gleeson R, Topliss C, Greenwood R, Harries WJ, Chesser TJ (2010) A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am 92(4):792–798CrossRefPubMed

Lindskog DM, Baumgaertner MR (2004) Unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 12(3):179–190CrossRefPubMed

Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P, Hip Fracture Study Group (2007) Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am 89(3):470–475CrossRefPubMed

Mohan R, Karthikeyan R, Sonanis SV (2000) Dynamic hip screw: does side make a difference? Effects of clockwise torque on right and left DHS. Injury 31(9):697–699CrossRefPubMed

10.

Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77(7):1058–1064PubMed

11.

Anglen JO, Weinstein JN, American Board of Orthopaedic Surgery Research Committee (2008) Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am 90:700–707CrossRefPubMed

12.

Forte ML, Virnig BA, Eberly LE, Swiontkowski MF, Feldman R, Bhandari M, Kane RL (2010) Provider factors associated with intramedullary nail use for intertrochanteric hip fractures. J Bone Joint Surg Am 92(5):1105–1114CrossRefPubMed

13.

Boone C, Carlberg KN, Koueiter DM, Baker KC, Sadowski J, Wiater PJ, Nowinski GP, Grant KD (2014) Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2). J Orthop Trauma 28(5):E96–E100CrossRefPubMed

14.

Hou Z, Bowen TR, Irgit KS, Matzko ME, Andreychik CM, Horwitz DS, Smith WR (2013) Treatment of pertorchanteric fractures (OTA 31-A1 and A2): long versus short ephalomedullary nailing. J Orthop Trauma 27(6):318–324CrossRefPubMed

15.

Norris R, Bhattacharjee D, Parker M (2012) Occurrence of secondary fracture around intramedullary nails used for trochanteric hip fractures: a systematic review of 13,568 patients. Injury 43:706–711CrossRefPubMed

16.

Vaughn J, Cohen E, Vopat BG, Kane P, Abbood E, Born C (2014) Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up. Eur J Orthop Surg Traumatol 25(4):665–670

17.

Kleweno C, Morgan J, Redshaw J, Harris M, Rodriguez E, Zurakowski D, Vrahas M, Appleton P (2014) Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. J Orthop Trauma 28(7):391–397CrossRefPubMed

18.

Welch V, Petticrew M, Tugwell P, Moher D, O’Neill J, Waters E, White H (2012) PRISMA-Equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity. PLoS Med 9(10):e1001333CrossRefPubMedPubMedCentral

19.

Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, GRADE Working Group et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490CrossRefPubMed

20.

Macario A (2010) What does one minute of operating room time cost? J Clin Anesth 22:233–236CrossRefPubMed

21.

Abouleish AE, Dexter F, Whitten CW, Zavaleta JR, Prough DS (2004) Quantifying net staffing costs due to longer-than-average surgical case durations. Anesthesiology 100:403–412CrossRefPubMed

22.

Available at: http://www1.salary.com/orthopedic-surgeon-hourly-wages.html. Accessed 1 March 2015

23.

Available at: http://www.healthcareworkersalary.com/physicians/orthopedic-surgeon-salary/?doing_wp_cron=1425325586.5546059608459472656250. Accessed 1 March 2015

24.

Swart E, Makhni EC, Macaulay W, Rosenwasser MP, Bozic KJ (2014) Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures. J Bone Joint Surg Am 96:1612–1620CrossRefPubMed

25.

Thakar C, Alsousou J, Hamilton TW, Willett K (2010) The cost and consequences of proximal femoral fractures which require further surgery following initial fixation. J Bone Joint Surg Br 92(12):1669–1677CrossRefPubMed

26.

Palmer SJ, Parker MJ, Hollingworth W (2000) The cost and implications of reoperation after surgery for fracture of the hip. J Bone Joint Surg Br 82(6):864–886CrossRefPubMed

27.

Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J (2005) Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg Am 87(3):570–576CrossRefPubMed

28.

Bozic KJ, Morshed S, Silverstein MD, Rubash HE, Kahn JG (2006) Use of costeffectiveness analysis to evaluate new technologies in orthopaedics. The case of alternative bearing surfaces in total hip arthroplasty. J Bone Joint Surg Am 88(4):706–714CrossRefPubMed

29.

Crowe JF, Sculco TP, Kahn B (2003) Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res 413:175–182CrossRefPubMed

Title: Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review
Authors: John Dunn
Nicholas Kusnezov
Julia Bader
Brian R. Waterman
Justin Orr
Philip J. Belmont
Publication date: 01-12-2016
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2016
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-016-0405-z

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Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

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