Lengths of intramedullary nails and treatment efficacy of osteoporotic unstable intertrochanteric fracture / 中华创伤骨科杂志

Objective:To investigate the effects of lengths of intramedullary nails on the treatment efficacy of osteoporotic unstable intertrochanteric fracture.Methods:Retrospectively analyzed were the data of patients with osteoporotic unstable intertrochanteric fracture who had been admitted to Department of Orthopedics, China-Japan Friendship Hospital from January 2017 to December 2019. According to the lengths of intramedullary nails, the patients were divided into 2 groups. In the short nail group of 135 cases, there were 38 males and 97 females with an age of (82.2 ± 7.7) years and an intramedullary nail with a length of 170 mm was used. In the long nail group of 32 cases, there were 8 males and 24 females with an age of (81.5±7.1) years and an intramedullary nail longer than 300 mm was used. The amount of intraoperative hemoglobin drop value, operation time, Harris hip score at 6 months after surgery, incidence of complications and mortality were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability between groups ( P>0.05). There were no significant differences between the 2 groups in intraoperative hemoglobin drop value [(19.8±2.2) g/L versus (20.0±2.1) g/L], Harris hip score (72.0±3.0 versus 71.2±3.6), incidence of complications [3.0% (4/135) versus 6.2 (2/32)] or mortality [14.3% (19/135) versus 15.6% (5/32)] ( P>0.05). The long nail group needed significantly longer operation time than the short nail group [(84.6±5.6) min versus (92.0±7.2) min] ( P<0.05). Conclusions:In the treatment of osteoporotic unstable intertrochanteric fracture, short and long intramedullary nails show no significant difference in hemoglobin drop value, functional score, complications or mortality, indicating they can both lead to safe and reliable curative efficacy. However, long nails need longer operation time.

The long and short of cephalomedullary nails in the treatment of osteoporotic pertrochanteric fracture

<p><b>INTRODUCTION</b>Pertrochanteric fractures after low-energy trauma are common among osteoporotic patients. Although the use of intramedullary devices to treat such fractures is becoming increasingly popular, there is a paucity of data comparing the outcomes of the use of short cephalomedullary nails (SCN) with the use of long cephalomedullary nails (LCN). This study aimed to compare the outcomes of treatment using LCN with treatment using SCN for patients with osteoporotic pertrochanteric fractures.</p><p><b>METHODS</b>A retrospective review of 64 patients with osteoporotic pertrochanteric fractures who were treated with either LCN or SCN and had a minimum follow-up of one year was performed. Primary outcome measures include complications, revision surgeries and union rates. Secondary outcome measures include duration of surgery, estimated blood loss, length of hospital stay, and ambulatory and mortality status at one year.</p><p><b>RESULTS</b>There was no significant difference in the clinical and functional outcomes of the patients who were treated with LCN and those who were treated with SCN. However, there was a higher incidence of heterotopic ossification in the latter group, and a slightly greater average estimated blood loss and duration of surgery in the former group. Patients treated with LCN tended to be more osteoporotic.</p><p><b>CONCLUSION</b>Our study found no significant difference in terms of complications, revision surgeries, union rates and ambulatory status between the patients who were treated with LCN and those who were treated with SCN. Both LCN and SCN provided safe and reliable outcomes in the treatment of osteoporotic pertrochanteric fractures.</p>

Treatment of Femur Subtrochanteric Fracture Using the Intramedullary Long Nail; Comparison of Closed Reduction and Minimal Open Reduction / 대한정형외과학회잡지

PURPOSE: The purpose of the study was to evaluate methods for treatment of femur subtrochanteric fractures using the intramedullary long nail. MATERIALS AND METHODS: This retrospective study included 44 patients (44 cases) who were available for follow-up for at least one year. The patients had undergone intramedullary fixation specifically with a long nail for traumatic femur subtrochanteric fractures during the period from June 2005 to May 2012 in Chosun University Hospital. The study compares two groups. For group 1, closed reduction was attempted, and group 2 underwent minimal open reduction. Group 1 included 27 cases, and group 2 included 17 cases. Study parameters included injury mechanism, fracture classification according to the Seinsheimer type, nail design, size of skin incision, alignment, bony union time, malunion or nonunion, and complications. RESULTS: Bony union times were 19.4 weeks (group 1) versus 21.4 weeks (group 2), but there were no statistical differences between the two groups with respect to gender, injury mechanism, fracture classification, or nail design. However, there were significant differences between the two groups with respect to skin incision, malalignment, and complications. Gender, injury mechanism, fracture classification, nail design, size of skin incision, minimal open reduction or close reduction, did not show a significant relationship with bony union. However, in cases of malalignment, the possibility of malunion increased 1.5 times per 1degrees increase in malaligment. CONCLUSION: In treatment of femur subtrochanteric fracture using intramedullary nail, nonunion rate increases when malalignment occurs. Therefore, anatomical reduction with minimal open reduction is necessary if closed reduction is not satisfactory.