Long Distally Unlocked Hip Nails versus Short Distally Locked Nails for Peritrochanteric Fractures: Operative Characteristics and Peri-implant Fracture Risks.

Abstract

To compare the primary outcome of surgical time for long, distally unlocked, intramedullary nails (LUIMNs) versus short, distally locked, intramedullary nails (SLIMNs) and to compare secondary outcomes of blood loss, peri-implant fractures, reoperation events, and mortality between these two groups. Design: Retrospective cohort study. One Level I Trauma Center and one community hospital. Patients older than 18 years of age treated with SLIMNs or LUIMNs for peritrochanteric hip fractures, OTA/AO 31A1, 31A2, 31A3, were included. The primary outcome was surgical time for LUIMNs versus SLIMNs. Secondary outcomes were estimated blood loss (EBL), peri-implant fracture rates, reoperation for nonunion or shortening, all-cause reoperation, and mortality within 2 weeks and 3 months of surgery for LUIMNs versus SLIMNs. There were 602 patients in the LUIMN group (68.6% female, 31.4% male), with an average age of 77.3 (range, 29-108). There were 142 patients in the SLIMN group (63.4% female, 36.6% male) with an average age of 75.3 (range 33-101). Average OR time for LUIMNs was 46.9 minutes compared to 53.7 minutes for SLIMNs (P < 0.001). Peri-implant fracture rates were 0.6% for LUIMNs and 4.1% for SLIMNs (P = 0.012). There was no difference in EBL between LUIMNs (103.8± 55.1) and SLIMNs (104.3 ± 87.8); bootstrap analysis showed a mean difference of 0.3 mL (95% CI -13.7 to 16.3; P = 0.97). There was no difference in all-cause reoperation (1.9% LUIMNs and 4.9% SLIMNs, P = 0.113), reoperation for nonunion (0.2% LUIMNs, 0% SLIMNs, P = 1.00), or reoperation for shortening (0.75% LUIMNs, 0% SLIMNs, P = 0.44). There was no significant difference in mortality at 2 weeks (2.8% LUIMNs, 2.5% SLIMNs, P = 0.891) and 3 months (7.1% LUIMNs, 9.8% SLIMNs, P = 0.292). For peritrochanteric hip fractures, long distally unlocked intramedullary nails reduced operative times and lowered the risk of peri-implant fracture compared to short distally locked intramedullary nails. Accordingly, they may be a preferred treatment option to reduce the risk of future fractures. Therapeutic Level III. See Instructions for Authors for a complete description for levels of evidence.