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

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Abstract

OBJECTIVES: 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. METHODS: Design: Retrospective cohort study. Setting: One Level I Trauma Center and one community hospital. Patient Selection Criteria: Patients older than 18 years of age treated with SLIMNs or LUIMNs for peritrochanteric hip fractures, OTA/AO 31A1, 31A2, 31A3, were included. Outcome Measures and Comparisons: 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. RESULTS: 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). CONCLUSIONS: 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. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description for levels of evidence.