Treatment of pertrochanteric fractures (OTA 31-A1 and A2): long versus short cephalomedullary nailing.

ABSTRACT

OBJECTIVES: To retrospectively compare the clinical outcomes in patients with pertrochanteric femur fractures without subtrochanteric extension (OTA 31-A1 and A2) after treatment with short or long cephalomedullary nails. DESIGN: Retrospective study. SETTING: Academic level I trauma center. PATIENTS Two hundred eighty three adult patients presenting with simple or multifragmentary pertrochanteric femur fractures (OTA 31-A1 and A2) between 2004 and 2009 qualified for inclusion in this study. INTERVENTION One hundred patients were treated with a short cephalomedullary nail and 183 with a long cephalomedullary nail. MAIN OUTCOME MEASUREMENTS Patient demographics and medical comorbidities were recorded for each patient via an electronic medical record. Treatment-related variables including the American Society of Anesthesiologists (ASA) score, duration of surgery, volume of intraoperative blood loss, need for blood products, treatment-related complications, and mortality were recorded and compared between the short and long nail groups. RESULTS: There were no significant difference between treatment modalities, complication, and reoperation rates for the 2 groups. Treatment with a long nail resulted in subtle increases in procedure time and blood loss. CONCLUSIONS: No differences in the union and complication rates between the 2 groups were identified, suggesting that long nails offer no advantage compared with short nails for stabilizing simple and multifragmentary pertrochanteric femur fractures without subtrochanteric extension (OTA 31-A1 and A2). LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.