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09.09.2020 | Original Article | Ausgabe 3/2021

European Journal of Orthopaedic Surgery & Traumatology 3/2021

How are peri-implant fractures below short versus long cephalomedullary nails different?

Zeitschrift:
European Journal of Orthopaedic Surgery & Traumatology > Ausgabe 3/2021
Autoren:
L. Henry Goodnough, Brett P. Salazar, Jamie Furness, James E. Feng, Malcolm R. DeBaun, Sean T. Campbell, Justin F. Lucas, William W. Cross, Philipp Leucht, Kevin D. Grant, Michael J. Gardner, Julius A. Bishop
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00590-020-02785-1) contains supplementary material, which is available to authorized users.

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Abstract

Background

Cephalomedullary nails are a commonly used implant for the treatment of many pertrochanteric femur fractures and are available in short and long configurations. There is no consensus on ideal nail length. Relative advantages can be ascribed to short and long intramedullary nails, yet both implant styles share the potentially devastating complication of peri-implant fracture. Determining the clinical sequelae after fractures below nails of different lengths would provide valuable information for surgeons choosing between short or long nails. Thus, the purpose of the study was to compare injury patterns and treatment outcomes following peri-implant fractures below short or long cephalomedullary nails.

Methods

This was a multicenter retrospective cohort study that identified 33 patients referred for treatment of peri-implant fractures below short and long cephalomedullary nails (n = 19 short, n = 14 long). We compared fracture pattern, treatment strategy, complications, and outcomes between these two groups.

Results

Short nails were associated with more diaphyseal fractures (odds ratio [OR] 13.75, CI 2.2–57.9, p 0.002), which were treated more commonly with revision intramedullary nailing (OR, infinity; p 0.01), while long nails were associated with distal metaphyseal fractures (OR 13.75, CI 2.2–57.9, p 0.002), which were treated with plate and screw fixation (p 0.002). After peri-implant fracture, there were no differences in blood loss, operative time, weight bearing status, or complication rates based on the length of the initial nail. In patients treated with revision nailing, there was greater estimated blood loss (EBL, median 300 cc, interquartile range [IQR] 250–1200 vs median 200 cc, IQR 100–300, p 0.03), blood product utilization and complication rates (OR 11.1, CI 1.1–135.7, p 0.03), but a trend toward unrestricted post-operative weight-bearing compared to patients treated with plate and screw constructs.

Conclusion

Understanding fracture patterns and patient outcomes after fractures below nails of different lengths will help surgeons make more informed implant choices when treating intertrochanteric hip fractures. Revision to a long nail for the treatment of fractures at the tip of a short nail may be associated with increased patient morbidity.

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