1Scott G, 1McDermott M, 2Chang A, 3Steimle J
1Kettering Health Dayton- Grandview, Dayton , OH, United States; 2undefined, undefined, OH, Undefined; 3Kettering Health Grandview, Dayton, OH, United States
BACKGROUND
Intertrochanteric femur (IT) fractures are a common injury in the elderly population that are associated with significant morbidity and mortality.1 Cephalomedullary nails (CMN) are the preferred treatment, however, there is controversy regarding optimal nail length. 1 Short nails are associated with faster procedures with lower blood loss, while long nails may provide more biomechanical stability but carry risks of increased complications. 1 This study aims to compare cephalomedullary nail lengths to evaluate differences in operative parameters, postoperative complications, and mortality rates.
METHODS
A retrospective review of patients receiving CMN for IT fractures from 2022 to 2024 was conducted. Patient demographics, surgical data, and postoperative outcomes were collected and compared based on CMN length.
RESULTS
The cohort included 141 patients with a mean age of 77.7 ± 12.0 years and a BMI of 24.8 ± 5.9 kg/m². The average Charlson Comorbidity Index was 5.6 ± 2.7, and the ASA score was 2.99 ± 0.5. Most fractures were classified as AO/OTA 31A1 (54.6%), followed by 31A2 (36.2%) and 31A3 (9.2%). All patients were treated with a CMN, with short nails used in 80 patients (56.7%), intermediate in 13 (9.2%), and long in 48 (34.0%). Patient demographics were similar across groups. Operative time increased with nail length, with long nails having the longest procedure time (105.2 ± 28.2 min), followed by intermediate (87.1 ± 22.3 min) and short nails (71.2 ± 20.1 min, p < 0.001). Postoperative hemoglobin drop was highest in the long nail group (2.8 ± 2.0 g/dL), compared to intermediate (2.4 ± 1.7 g/dL) and short nails (1.8 ± 2.0 g/dL, p = 0.032). Transfusion rates also increased with nail length, with 62.5% of long nail patients requiring transfusion, compared to 53.8% of intermediate and 30.0% of short nail patients (p = 0.001). Despite these differences, hospital length of stay was similar across groups (5.2 ± 3.1 days, p = 0.460). Postoperative complications occurred in 62.4% of patients, with no significant difference between nail types (p = 0.386). However, postoperative anemia was significantly higher in the long nail group (43.8%) compared to intermediate (38.5%) and short nails (20%, p = 0.014). Acute kidney injury was also more frequent with long nails (16.7%) compared to intermediate (0%) and short nails (5.0%, p = 0.017). Reoperation rates were low (3.5%) and similar between groups (short: 5.0%, intermediate: 0.0%, long: 2.1%, p = 0.529). Mortality rates at 30, 60, and 90 days were 6.4%, 10.6%, and 12.8%, respectively, with no differences between nail groups (p = 0.957).
CONCLUSIONS
Longer nails increased operative time, hemoglobin drop, and transfusion rates, yet complication rates, reoperations, and mortality were similar across groups. Given these findings, short nails may be the preferred choice unless specific fracture characteristics necessitate a longer implant.
