Enns Paul A, Nyberg Sue M, Berg Gina M, Galliart Morgan A, Sarauer Brent D, Scheer Andrew A, Dart Bradley R, Corrigan Chad M
University of Kansas School of Medicine-Wichita, Department of Orthopedics.
Wichita State University, Department of Physician Assistant.
Kans J Med. 2020 May 21;13:106-111. eCollection 2020.
Hip fracture is a major cause of morbidity and mortality in older adults. Intertrochanteric hip fractures often are treated surgically using cephalomedullary nails (CMN), in either a short or long length. Their outcomes are documented in the literature; however, outcomes of the intermediate-length CMN have not been well described.
A retrospective review was conducted of older adults with intertrochanteric hip fractures that were treated with cephalomedullary nail fixation using an intermediate-length (235 mm Synthes Trochanteric Fixation nail or 240 mm Stryker Gamma 3) nail. Outcome data were collected during the inpatient stay and 16 months post-operatively.
Seventy-seven patients met inclusion criteria and were reviewed during inpatient stay; however, only 42 had documented post-operative outcomes. Of those, two patients died post-discharge and were not included in the 16-month follow-up. Comparison of results to published literature suggested that intermediate-length nails are comparable to short-length nails with regard to time in the operating room and estimated blood loss. The rate of blood transfusion was lower and length of hospital stay was shorter than in comparable studies of both short- and long-length nails. There were no post-operative peri-prosthetic fractures in the 16-month follow-up. This rate was lower than published rates for short and long nails. The hardware failure rate (3/42, 7.1%) of intermediate-length nails was higher than comparison studies of both short- and long-length nails.
Patient outcomes for intermediate-length nails were similar to outcomes of shorter length nails. Utilization of the intermediate-length nail appears to be an effective treatment option for repair of intertrochanteric femur fractures. However, direct comparison is difficult since peri-prosthetic fracture rate may increase over time and nail length and hardware failure are not defined consistently in the literature. Further study is needed with a larger sample size followed over a longer period of time to confirm our findings.
髋部骨折是老年人发病和死亡的主要原因。股骨转子间骨折通常采用头髓内钉（CMN）进行手术治疗，钉的长度有短有长。其治疗结果已有文献记载；然而，中等长度CMN的治疗结果尚未得到充分描述。
对采用中等长度（235mm的Synthes股骨转子间固定钉或240mm的Stryker Gamma 3）头髓内钉固定治疗股骨转子间骨折的老年人进行回顾性研究。在住院期间和术后16个月收集结果数据。
77例患者符合纳入标准并在住院期间接受了评估；然而，只有42例有术后结果记录。其中，2例患者出院后死亡，未纳入16个月的随访。与已发表文献的结果比较表明，中等长度的钉子在手术时间和估计失血量方面与短钉相当。输血率低于短钉和长钉的同类研究，住院时间也较短。在16个月的随访中未发生术后假体周围骨折。该发生率低于短钉和长钉的已发表发生率。中等长度钉子的内固定失败率（3/42，7.1%）高于短钉和长钉的比较研究。
中等长度钉子的患者治疗结果与较短长度钉子的结果相似。使用中等长度钉子似乎是修复股骨转子间骨折的一种有效治疗选择。然而，由于假体周围骨折率可能随时间增加，且文献中钉的长度和内固定失败的定义不一致，因此难以进行直接比较。需要进行更大样本量、更长时间的进一步研究以证实我们的发现。
