Comparative Efficacy in Pertrochanteric Fractures: A Randomized Controlled Trial of the Shortest Versus Various Short-Length Cephalomedullary Nails.

Abstract

Background: The optimal length of cephalomedullary nails for treating unstable pertrochanteric fractures, particularly in populations with distinct femoral anatomy, remains debated. This study compares the clinical outcomes of using the shortest effective cephalomedullary nails (170 mm) to various short length (200 mm and 240 mm), focusing on Asian patients. Methods: In this randomized controlled trial, 50 patients aged 50 years or older with unstable intertrochanteric fractures (AO types 31A2-3) were randomly assigned to two groups. The shortest-nail group (n = 25) received a 170 mm cephalomedullary nail, while the control group (n = 25) received either a 200 mm or 240 mm nail based on patient height. Primary outcomes were assessed using the Harris Hip Score (HHS) at multiple postsurgery intervals. Secondary outcomes included operative time, hospital stay, hidden blood loss (HBL) (calculated using Sehat's formula), and complication rates. Results: There were no significant differences in HHSs, hospital stay durations, or operative times between the two groups. The median time to fracture union was also comparable between groups (18.1 weeks vs. 18.2 weeks, p=0.9). However, the shortest-nail group showed significantly lower HBL (860.52 mL) compared with the control group (1183.40 mL, p=0.04). Complications included five cases of blade cut-out or refracture, with no significant differences between groups. Conclusion: The shortest effective cephalomedullary nails (170 mm) may offer benefits, particularly in reducing HBL, compared with various short-length nails. However, this advantage may not be solely attributable to nail length, as both groups underwent similar surgical techniques and other factors, such as fracture patterns or patient anatomy, may have influenced the outcomes. While short nails are effective for treating unstable pertrochanteric fractures, larger studies with longer follow-up periods are necessary to validate these findings and assess the long-term safety and efficacy of short nails.