Don't Be Silly, The Short Rod Is Quick, Easy and Effective in Treating Hip Intertroch Fractures Gil R. Ortega, MD, MPH Sonoran Orthopaedic Trauma Surgeons Orthopaedic Trauma Director, Mayo Clinic Arizona Residency Program Vice Chair, Department of Surgery, Scottsdale Osborn Level 1 Trauma Center, Scottsdale, AZ, USA
Disclosures • Founding Member, Orthopaedic Board of Advisors: Carbofix • Founding Member, Orthopaedic Board of Advisors: Artross Nanobone • Consultant: Smith and Nephew
Remember This One Slide and Do the Right Thing for Your Patients…Use a Short Nail for IT fractures • Less blood loss with Short Nail • Less OR time with Short Nail • Less Fluoro time with Short Nail • Lower Cost with Short Nail • Lower incidence of anterior femoral cortical penetration • Similar refracture rates with short and long nails
Why the Shift to Long Nails? • Protect the entire femur? • More Stable construct? • Avoid fracture with short nail? • Making more money for ortho companies? • Size and length are important?
Long Nail or Short Nail? • 409 patients presenting to a Level I trauma center with pertrochanteric fractures were retrospectively reviewed • 283 patients – 100 patients were treated with a short nail (170 mm) and 183 with a long nail – All patients were treated with a single nail design having identical proximal fixation – Choice of long versus short nail was based on surgeon preferences OTA Paper Oct. 2012 and J Orthop Trauma. 2013 Jun;27(6):318-24. doi: 10.1097/BOT.0b013e31826fc11f.. Treatment of Pertrochanteric Fractures (AO/OTA 31-A1 and A2): Long Versus Short Cephalomedullary Nailing Kaan S. Irgit, MD; Zhiyong Hou, MD; Thomas R. Bowen, MD; Michelle E. Matzko, PhD; Cassondra M. Andreychik, BA; Daniel S. Horwitz, MD; Wade R. Smith, MD
Long Nail or Short Nail? • No significant difference in postoperative mortality rates between two groups • No clinically significant difference in outcomes • Patients treated with short nails had, on average, shorter operative times • Long nails offer no clinical advantage unless subtrochanteric extension • Increased cost of long nail (~$500 more) and greater operative time compared to short nails may not justify use of long nail in treatment of simple and multifragmentary pertrochanteric femur fractures OTA Paper Oct. 2012 and J Orthop Trauma. 2013 Jun;27(6):318-24. doi: 10.1097/BOT.0b013e31826fc11f.. Treatment of Pertrochanteric Fractures (AO/OTA 31-A1 and A2): Long Versus Short Cephalomedullary Nailing Kaan S. Irgit, MD; Zhiyong Hou, MD; Thomas R. Bowen, MD; Michelle E. Matzko, PhD; Cassondra M. Andreychik, BA; Daniel S.
Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years • Compare failure rates between short and long cephalomedullary nails used for intertrochanteric hip fractures in patients over 65 years of age at three level 1 trauma centers • Open reduction and internal fixation of intertrochanteric hip fracture with either short or long cephalomedullary nail
Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years • There were 11 of 559 (2.0%) patients who sustained a periprosthetic fracture after nailing, 6 of 219 (2.7%) after short nails and 5 of 340 (1.5%) after long nails (P = 0.35). • Short and long nails have same treatment failure rates • Kleweno et al. J OrthopTrauma 2014 Jul;28(7):391-7
Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review • Compare clinical outcomes between long and short CMN in treatment of trochanteric hip fractures • Literature search done
Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review • Included in analysis were 1276 patients, with 438 short and 838 long CMN • Rate of reoperation was 5.0% and 3.8% for short and long CMN, respectively ( P = 0.31) • Rate of refracture was 1.6% and 0.95% for short and long CMN, respectively ( P = 0.41)
Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review • As compared to long nails, short nails – Average blood loss of 39 mL less ( P = 0.0003) – 8.8 % decrease in transfusion rate ( P = 0.07) – 19 min less operative time ( P < 0.0001) – No significant differences between short and long nails were observed for either other complications, hardware complications, non- union, or mortality • John Dunn et al. Journal of Orthopaedics and Traumatology. December 2016, Volume 17, Issue 4, pp 361–367
Remember This One Slide and do the right thing for your patients…Use a Short Nail for IT fractures • Less blood loss with Short Nail • Less OR time with Short Nail • Less Fluoro time with Short Nail • Lower Cost with Short Nail • Lower incidence of anterior femoral cortical penetration • Similar refracture rates with short and long nails
Thank You
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