title: Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail?
abstract: BACKGROUND
  Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing.
  
  
  OBJECTIVE
  We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate.
  
  
  METHODS
  We conducted a pilot prospective randomized controlled trial comparing standard versus long (≥ 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months).
  
  
  RESULTS
  We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm).
  
  
  CONCLUSIONS
  Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Celal Bayar University, Manisa, 45250, Turkey. ggokcu@hotmail.com
authors.forename: Güvenir
authors.initials: G
authors.lastname: Okcu
authors.forename: Nadir
authors.initials: N
authors.lastname: Ozkayin
authors.forename: Cemil
authors.initials: C
authors.lastname: Okta
authors.forename: Ismet
authors.initials: I
authors.lastname: Topcu
authors.forename: Kemal
authors.initials: K
authors.lastname: Aktuglu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome
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