Periprosthetic Fracture Rate After Short and Long Hip Nails: Analysis of a Regional Health Database

Introduction: Intertrochanteric hip fractures are a major socio-economic burden, and a significant source of morbidity and mortality. Treatment is generally surgical, with either a dynamic hip screw or a cephalomedullary hip nail. Recently, there has been a trend toward the use of hip nails. The use of short nails over long nails, which span the length of the femur, remains a source of controversy. Historically, short nails were associated with a higher periprosthetic fracture rate compared with long nails, however newer nail designs, appear to have resolved this issue. Small retrospective studies show a refracture rate similar in both long and short nails. Given the small sample size of current studies, it remains unclear if the refracture rate is indeed the same between treatment arms, or if studies are not sufficiently large to identify a difference between the two. A large database review would provide the practical next step to further explore this question.

Methods: Intertrochanteric hip fracture cases from our Regional Hip Fracture Registry were reviewed. All patients with an intertrochanteric fracture treated with a cephalomedullary nail from June 2009 to December 2017 were included. Patient demographics were compared using the t-test. Fracture rate was compared using the chi square test.

Results: 655 short nails and 315 long nails were reviewed. Patients in the short nail (SN) group were older than in the long nail group (LN) (SN: 81, LN 76 p < 0.001). The periprosthetic fracture rate was 2.1% overall with 1.3% in LN group and 2.4% in SN group (p = 0.34). There was no difference identified in the rate of blood transfusions (SN 38% LN 40% p = 0.5), however the procedure time was shorter in the SN group (SN: 81 min LN: 112 min p < 0.001).

Discussion: This study did not find a statistical difference in periprosthetic fracture rate when comparing short and long cephalomedullary nails for the treatment of intertrochanteric fractures. Procedure time was shorter in the SN group. However, no difference in rate of blood transfusion was noted between patient groups. This study supports use of both nail type for hip fracture fixation, on the basis of periprosthetic fracture rate.