Comparison of Functional Outcomes Between Short and Long Cephalomedullary Nails in Intertrochanteric Femur Fractures in Elderly Patients.

INTRODUCTION

Cephalomedullary nails (CMNs) are the most commonly used surgical implants for the treatment of intertrochanteric fractures in the geriatric population. However, there remains ongoing debate regarding the long-term benefits and complication risks associated with the length of CMNs, short (<250 mm) versus long (>250 mm), in managing these fractures. This study aims to compare the functional outcomes between short and long CMNs using the Harris Hip Score (HHS) and assess the complication rates associated with each type.

METHOD

The study included 50 patients aged 60-85 years who underwent cephalomedullary femoral nailing, either short or long, for Association for Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) type 31A1 and 31A2 trochanteric femur fractures. Data collected included duration of hospitalization, operative time, intraoperative blood loss, time to radiological union, time to weight-bearing, postoperative pain assessed using the Visual Analogue Scale (VAS), and complications such as anterior thigh pain and screw cutout or backout. Functional outcomes were evaluated using the HHS. Follow-ups were conducted at 5 days, 14 days, 30 days, 3 months, 6 months, and 8 months postoperatively.

RESULTS

A total of 25 patients were treated with short and long CMNs. The short nail group showed significantly lower intraoperative blood loss (94.84 ± 11.1 mL vs. 117.24 ± 25.81 mL, p = 0.01) and shorter operative time (51.84 ± 4.37 min vs. 56.40 ± 2.74 min, p = 0.01). No significant differences were observed in hospital stay, time to weight-bearing, or radiological union. At eight months, the VAS score was significantly better in the short nail group (p = 0.002). HHS scores were comparable in the early postoperative period but significantly favored the short nail group at three months (p = 0.00), six months (p = 0.002), and eight months (p = 0.02). Screw backout occurred in one patient (4%) in the long nail group and two patients (8%) in the short nail group (p = 0.551), while anterior thigh pain was reported in five patients (20%) in the short nail group and one patient (4%) in the long nail group (p = 0.081); however, these complications were not statistically significant.

CONCLUSION

This study contributes to the existing body of evidence by demonstrating that both short and long CMNs are viable treatment options for trochanteric fractures. However, our findings indicate that short CMNs may offer certain advantages, including reduced intraoperative blood loss, shorter operative time, and improved functional outcomes as assessed by the HHS.