nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

23.01.2021 | Orthopaedic Surgery

Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients

verfasst von: Mark E. Cinque, L. Henry Goodnough, Blake J. Schultz MD, Andrew T. Fithian, Malcolm DeBaun, Justin F. Lucas, Michael J. Gardner MD, Julius A. Bishop

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 7/2022

Einloggen, um Zugang zu erhalten

Abstract

Objectives

The purpose of the study was to compare treatment outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures.

Data sources

A systematic review of perioperative outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures was performed. The following databases were used: using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980–2019), and MEDLINE (1980–2019). The queries were performed in June 2019.

Study selection

The following search term query was used: “Intramedullary Nail AND Intertrochanteric Fracture OR “Long OR Short Nail AND intertrochanteric Fracture.” Studies were excluded if they were “single-arm” studies (i.e., reporting on either long or short CMN but not both), or did not report at least one of the outcomes being meta-analyzed. Furthermore, cadaveric studies, animal studies, basic science articles, editorial articles, surveys and studies were excluded.

Data extraction

Two investigators independently reviewed abstracts from all identified articles. Full-text articles were obtained for review if necessary, to allow further assessment of inclusion and exclusion criteria. Additionally, all references from the included studies were reviewed and reconciled to verify that no relevant articles were missing from the systematic review.

Data synthesis

Short nails were associated with statistically significantly less estimated blood loss and operative time compared to long nails. There were no significant differences in transfusion rates, implant failures or overall re-operation rates between implant lengths. Similarly, there was no significant difference in peri-implant fracture between implant lengths.

Conclusions

Overall, the available clinical evidence supports the use of short cephalomedullary nails for the majority of intertrochanteric femur fractures.

Study design/level of evidence

Meta-analysis; Level III, therapeutic.

Niu E, Yang A, Harris AH, Bishop J (2015) Which fixation device is preferred for surgical treatment of intertrochanteric hip fractures in the united states? a survey of orthopaedic surgeons. ClinOrthopRelat Res 473(11):3647–3655

Anglen JO, Weinstein JN (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 90(4):700–707CrossRef

Werner BC, Fashandi AH, Gwathmey FW, Yarboro SR (2015) Trends in the management of intertrochanteric femur fractures in the United States 2005–2011. Hip Int 25(3):270–276CrossRef

Hulet DA, Whale CS, Beebe MJ, Rothberg DL, Gililland JM, Zhang C et al (2019) Short versus long cephalomedullary nails for fixation of stable versus unstable intertrochanteric femur fractures at a Level 1 Trauma Center. Orthopedics 42(2):e202–e209CrossRef

Shannon SF, Yuan BJ, Cross WW 3rd, Barlow JD, Torchia ME, Holte PK et al (2019) Short versus long cephalomedullary nails for pertrochanteric hip fractures: a randomized prospective study. J Orthop Trauma 33(10):480–486CrossRef

Liu J, Frisch NB, Mehran N, Qatu M, Guthrie ST (2018) Short-term medical complications following short versus long cephalomedullary nails. Orthopedics 41(5):e636–e642CrossRef

Krigbaum H, Takemoto S, Kim HT, Kuo AC (2016) Costs and Complications of short versus long cephalomedullary nailing of OTA 31–A2 proximal femur fractures in US veterans. J Orthop Trauma 30(3):125–129CrossRef

Dunn J, Kusnezov N, Bader J, Waterman BR, Orr J, Belmont PJ (2016) Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review. J OrthopTraumatol 17(4):361–367

Boone C, Carlberg KN, Koueiter DM, Baker KC, Sadowski J, Wiater PJ et al (2014) Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31–A1 and A2). J Orthop Trauma 28(5):e96–e100CrossRef

10.

Frisch NB, Nahm NJ, Khalil JG, Les CM, Guthrie ST, Charters MA (2017) Short versus long cephalomedullary nails for pertrochanteric hip fracture. Orthopedics 40(2):83–88CrossRef

11.

Guo XF, Zhang KM, Fu HB, Cao W, Dong Q (2015) A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly. Chin J Traumatol 18(6):332–335CrossRef

12.

Okcu G, Ozkayin N, Okta C, Topcu I, Aktuglu K (2013) Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail? Clin Orthop Relat Res 471(9):2768–2775CrossRef

13.

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

14.

Li Z, Liu Y, Liang Y, Zhao C, Zhang Y (2015) Short versus long intramedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years. Int J ClinExp Med 8(4):6299–6302

15.

Kanakaris NK, Tosounidis TH, Giannoudis PV (2015) Nailing intertrochanteric hip fractures: short versus long; locked versus nonlocked. J Orthop Trauma 29(Suppl 4):S10–S16CrossRef

16.

Hou Z, Bowen TR, Irgit KS, Matzko ME, Andreychik CM, Horwitz DS et al (2013) Treatment of pertrochanteric fractures (OTA 31-A1 and A2): long versus short cephalomedullary nailing. J Orthop Trauma 27(6):318–324CrossRef

17.

Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Joint Surg 85(1):1–3CrossRef

18.

Schumm WR, Higgins M, Lockett L, Huang S, Abdullah N, Asiri A et al (2017) Does dividing the range by four provide an accurate estimate of a standard deviation in family science research? a teaching editorial. Marriage Fam Rev 53(1):1–23CrossRef

19.

Shin WC, Lee ES, Suh KT (2018) The difference between short and long intramedullary nailing as the treatment for unstable intertrochanteric femoral fracture (AO/OTA 31-A2) in elderly patients. J Korean OrthopAssoc 52(1):25–32CrossRef

20.

Sellan M, Bryant D, Tieszer C, Papp S, Lawendy A, Liew A et al (2019) Short versus long InterTAN fixation for geriatric intertrochanteric hip fractures: a multicentre head-to-head comparison. J Orthop Trauma 33(4):169–174CrossRef

21.

Luo X, He S, Li Z, Li Q (2020) Quantification and influencing factors of perioperative hidden blood loss during intramedullary fixation for intertrochanteric fractures in the elderly. Arch Orthop Trauma Surg 140(10):1339–1348CrossRef

22.

Luque Pérez R, ChecaBetegón P, Galán-Olleros M, Arvinius C, Valle-Cruz J, Marco F (2020) Nailing unstable pertrochanteric fractures: does size matters? Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03668-0CrossRefPubMed

23.

Robinson CM, Adams CI, Craig M, Doward W, Clarke MC, Auld J (2002) Implant-related fractures of the femur following hip fracture surgery. J Bone Joint Surg 84(7):1116–1122CrossRef

24.

Bhandari M, Schemitsch E, Jonsson A, Zlowodzki M, Haidukewych GJ (2009) Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis. J Orthop Trauma 23(6):460–464CrossRef

25.

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 OrthopSurgTraumatol 25(4):665–670

26.

Murena L, Moretti A, Meo F, Saggioro E, Barbati G, Ratti C et al (2018) Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients. Arch Orthop Trauma Surg 138(3):351–359CrossRef

27.

Hong CC, Nashi N, Makandura MC, Tan JH, Peter L, Murphy D (2017) The long and short of cephalomedullary nails in the treatment of osteoporotic pertrochanteric fracture. Singap Med J 58(2):85–91CrossRef

28.

Zhang W, Antony Xavier RP, Decruz J, Chen YD, Park DH (2020) Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03399-2CrossRefPubMed

29.

Horwitz DS, Tawari A, Suk M (2016) Nail length in the management of intertrochanteric fracture of the femur. J Am AcadOrthopSurg 24(6):e50–e58

30.

Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C (2009) Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma 23(7):485–492CrossRef

Titel: Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients
verfasst von: Mark E. Cinque
L. Henry Goodnough
Blake J. Schultz MD
Andrew T. Fithian
Malcolm DeBaun
Justin F. Lucas
Michael J. Gardner MD
Julius A. Bishop
Publikationsdatum: 23.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 7/2022
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03752-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Short versus long cephalomedullary nailing of intertrochanteric fractures: a meta-analysis of 3208 patients