Journal Article

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

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

2022

Overview

ObjectivesThe purpose of the study was to compare treatment outcomes after short or long cephalomedullary nailing for intertrochanteric femur fractures.Data sourcesA 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 selectionThe 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 extractionTwo 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 synthesisShort 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.ConclusionsOverall, the available clinical evidence supports the use of short cephalomedullary nails for the majority of intertrochanteric femur fractures.Study design/level of evidenceMeta-analysis; Level III, therapeutic.

• Publisher: Springer Nature B.V
• Subject: Collaboration / Failure / Fractures / Meta-analysis / Orthopedics / Postoperative period / Queries / Surgery / Systematic review / Trauma