Short Versus Long Nails in Treating Subtrochanteric Hip Fractures: A Systematic Review and Meta-analysis of Complication Rates.

Abstract

Background: Subtrochanteric hip fractures present a treatment challenge due to their varied etiologies, complexity, and associated complications. While intramedullary nailing is the standard treatment, the choice between short and long nails remains controversial. The aim of this meta-analysis was to compare the complication rates of short versus long cephalomedullary nail fixation in the treatment of subtrochanteric hip fractures.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, and CINAHL databases were searched for relevant studies up to May 2025. Inclusion criteria comprised studies directly comparing short and long nails in treating subtrochanteric fractures, including randomized controlled trials and comparative studies. Data synthesis and statistical analysis were performed using RevMan 5.23.5 software.

Results: After screening, 5 retrospective comparative studies met the inclusion criteria, encompassing a total of 4,384 subtrochanteric fracture subjects. The weighted mean age was 82 years, with women representing 70.7% of the sample. Implant failure (odds ratio [OR] 2.12; 95% confidence interval [CI] [1.15-3.92]; p = 0.02) and peri-implant fractures (OR 4.03; 95% CI [1.46-11.14]; p = 0.007) were significantly more common with short nails. The reoperation rate was higher with short nails but not statistically significant (OR 1.33; 95% CI [0.87-2.04]; p = 0.19). No significant differences were observed between groups for nonunion (OR 0.96; 95% CI [0.40-2.33]; p = 0.94), deep infection (OR 0.70; 95% CI [0.23-2.17]; p = 0.40), or 1-year mortality (OR 0.83; 95% CI [0.43-1.58]; p = 0.57).

Conclusion: The use of short nails in the management of subtrochanteric hip fractures is associated with higher rates of implant failure and peri-implant fractures, with equivalent rates of nonunion, infection, 1-year mortality, and reoperation. These findings highlight the need for a well-conducted trial to assess the overall benefits and to determine the lowest level of subtrochanteric fracture that can be safely treated with short nails.

Level of evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.