Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study.

OBJECTIVE: To compare functional and clinical outcomes in patients with pertrochanteric hip fractures treated with either a short (SN) or long (LN) cephalomedullary nail. DESIGN: Prospective, randomized. SETTING: Clinical investigation was performed at the Mayo Clinic's Level 1 Trauma Center in Rochester, MN. PATIENTS/PARTICIPANTS: Two hundred twenty patients with intertrochanteric fractures were prospectively randomized to an SN or LN cohort. A total of 168 patients (SN, n = 80; LN, n = 88) had a mean follow-up of 13.9 months. Fifty-two patients did not meet the minimum 3-month follow-up. Demographics were comparable between the cohorts. MAIN OUTCOME MEASURES: The primary outcome measurement was functional outcome evaluated by Short Form (SF-36) and Harris Hip scores (HHS) at 3 months. Secondary outcomes included implant failure, peri-implant fracture, mortality, operative time, estimated blood loss, and reoperation. RESULTS: SN and LN cohorts were comparable in all aspects of the SF-36. There was a clinically insignificant difference in the HHS between cohorts. Patients treated in the SN cohort experienced shorter operative times but did not differ in tip-to-apex distance or subtrochanteric fracture extension. There was no difference in implant cutout, deep surgical site infection, or peri-implant fractures. CONCLUSIONS: Patients treated with SNs or LNs for pertrochanteric femur fractures experienced comparable functional outcomes as measured by SF-36 and HHS. When compared with the LN cohort, SN patients experienced no difference in peri-implant fracture or lag-screw cutout and tolerated up to 3 cm of subtrochanteric fracture line extension. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Does Ankle Aspiration for Acute Ankle Fractures Result in Pain Relief? A Prospective Randomized Double-Blinded Placebo Controlled Trial.

OBJECTIVES: Does ankle aspiration help with pain control in patients with ankle fractures? DESIGN: Prospective, double-blind, randomized, placebo-controlled trial. SETTING: Level 1 Academic Medical Center. PATIENTS/PARTICIPANTS: Consecutive skeletally mature patients with ankle fractures. INTERVENTION: Randomized between ankle aspiration and sham procedure. MAIN OUTCOME MEASUREMENTS: Pain scores for 72 hours after injury and pain medicine usage. RESULTS: Comparison between study subjects receiving ankle aspiration and sham procedure showed no significant differences in pain scores acutely in the emergency department or within 3 days after injury. There were also no statistically significant differences in pain medicine usage within 3 days after injury. Secondary outcomes, including lower leg volume, 6-month functional outcome scores, and complication rate, also showed no significant differences between subjects receiving aspiration and the sham procedure. CONCLUSIONS: Aspiration of acute ankle fractures does not result in decreased pain scores or opioid usage after aspiration. Aspiration of acute ankle fractures does not provide measurable clinical benefit. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.