Treatment of Intertrochanteric Femur Fractures with Long versus Short Cephalomedullary Nails

Context Prior studies regarding indications for long vs short cephalomedullary nails in the treatment of intertrochanteric fractures had limited sample sizes and follow-up, suggesting a need for further investigation. Objective To evaluate the association between cephalomedullary nail length and outcomes for the treatment of intertrochanteric femur fractures. Design Cohort study using Kaiser Permanente's Hip Fracture Registry. A total of 5526 patients who underwent surgical treatment with cephalomedullary nails for an intertrochanteric femur fracture (2009-2014) were identified: 3108 (56.2%) with long nails and 2418 (43.8%) with short nails. Cox proportional hazards model regression was used to evaluate risks of all-cause revision and revision for periprosthetic fracture. Linear regression was used to evaluate operative time, estimated blood loss, and length of stay. Propensity score weights were used in all models to balance nail groups on patient and device characteristics. Main outcome measures All-cause revision surgery. Results No association was found in risk of all-cause revision (hazard ratio = 0.75, 95% confidence interval [CI] = 0.48-1.15) or revision for periprosthetic fracture (hazard ratio = 0.59, 95% CI = 0.23-1.48) for long nails compared with short nails. Use of longer nails resulted in 18.80 more minutes of operative time (95% CI = 17.33-20.27 minutes), 41.10 mL more of estimated blood loss (95% CI = 31.71-50.48 mL), and a longer hospitalization (8.4 hours; β = 0.35, 95% CI = 0.12-0.58 hours). Conclusion These findings suggest that routine use of short cephalomedullary nails is safe and effective in the treatment of intertrochanteric fractures.