Title : Short versus long cephalomedullary nailing of intertrochanteric fractures: A systematic review and meta analysis on 668 patients
Abstract:
Background: Intertrochanteric fractures are among the most common fractures in the older population and significantly contribute to morbidity and mortality. These fractures typically result from simple falls and require surgical intervention to restore mobility and prevent complications. Cephalomedullary nails are the most used fixation technique for intertrochanteric hip fractures, which were traditionally managed with a sliding hip screw and side plate. This discussion will compare the two techniques and evaluate their effectiveness in managing intertrochanteric fractures.
Methods: A comprehensive search was conducted across multiple databases to identify relevant studies for inclusion in this systematic review. The following databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ScienceDirect, Scopus, and Web of Science. Primary endpoints included complications, length of hospital stay, mortality, and functional measures such as the Harris Hip Score (HHS). The risk ratios (RRs) were calculated using a random-e?ects model.
Results: The results of this study highlight the utilization of long over short intramedullary nailing in decreasing the among patients with intertrochanteric femur fractures. However, short intramedullary nailing was superior in terms of reducing the surgical time, return to pre-fracture state, fewer re-opening and mortality rates, as well as lesser perioperative and total blood loss.
Conclusion: Long intramedullary demonstrates superior clinical outcomes in terms of loss of reduction, peri-implant fracture, varus malalignment, however, short nailing has demonstrated reduced surgical time, as well as less blood loss, re-opening and mortality rates, and return to prefracture state.
