A systematic review of short versus long intramedullary fixation in the management of pertrochanteric fractures

Introduction The aim was to determine whether there is a significant difference in clinical outcomes when using short vs. long nails for pertrochanteric femur fractures. Methods A systematic literature search was undertaken of Pubmed and Embase in April 2016. All papers published in English reporting studies comparing long vs. short nails for pertrochanteric femur fractures were studied. Data were pooled for blood loss and transfusion requirement, operative time, length of stay, incidence of delayed or non-union, incidence of avascular necrosis or infection, fracture or metalware failure and was analysed to examine the differences between long and short nails. Results From 90 potential studies, nine were considered to be eligible for inclusion. The short nail resulted in a statistically significant benefit when looking at transfusion requirement (p = 0.02); however, blood loss was not statistically different (p = 0.33) Operative time was also quicker with the short nail (p = 0.004), but the length of stay was no different (p = 0.41). When examining complications and fixation outcomes, there was no difference in delayed union rates (p = 0.29) and non-union rates (p = 0.19) nor when looking at metalware failure (p = 0.41) and fracture (p = 0.14). Discussion The use of short intramedullary nails for pertrochanteric femur fractures appeared to be beneficial when looking at transfusion requirements and operative time. When looking at complications such as fracture and metalware failure, despite there being a slightly higher incidence of these in the short nail group, it is not statistically significant. This study advocates that both devices are safe to use, however, the short nail may have some perceived benefits in reducing transfusion requirements and have cost benefits with a shorter operative time.