title: Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (OTA 31-A1 and A2).
abstract: OBJECTIVE
  The purpose of this study was to compare blood loss and operative times associated with long versus short intramedullary nails for intertrochanteric fracture fixation and rate of periprosthetic fracture.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  One hundred ninety-four patients with an intertrochanteric fracture (AO/OTA class 31-A1 and A2) and low-energy mechanism of injury treated by 1 of 4 fellowship-trained orthopaedic traumatologists.
  
  
  METHODS
  Short versus long intramedullary nail.
  
  
  METHODS
  Medical records were reviewed for age, gender, estimated blood loss (EBL), transfusion rate, operative time, length of stay, and incidence of periprosthetic fracture. Variables were statistically compared between long and short intramedullary nails, with statistical significance at P < 0.05.
  
  
  RESULTS
  The average EBL (135.5 ± 91.9 mL) and transfusion rate (57.1%) for long nails were found to be significantly greater (P = 0.002) than the EBL (92.6 ± 47.2 mL) and transfusion rate (40.2%) for short nails. Average operative time was also found to be significantly greater (P < 0.001) for long (56.8 ± 19.4 minutes) than for short (44.0 ± 10.7 minutes) intramedullary nail procedures. The overall incidence of periprosthetic fracture was 0.5%, one patient with initial treatment of a long intramedullary nail.
  
  
  CONCLUSIONS
  Statistically significant lower operative time, EBL, and transfusion rate were found in this study for short intramedullary nails. There were no differences seen in length of stay or periprosthetic fracture. The incidence of periprosthetic fracture was very low in both cohorts. Further study with greater statistical power is needed.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Departments of *Orthopaedic Surgery, and †Orthopaedic Research, William Beaumont Hospital, Royal Oak, MI.
authors.forename: Christopher
authors.initials: C
authors.lastname: Boone
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Carlberg
authors.forename: Denise M
authors.initials: DM
authors.lastname: Koueiter
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Baker
authors.forename: Jason
authors.initials: J
authors.lastname: Sadowski
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Wiater
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nowinski
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Grant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001858:Bone Nails / Q000009:adverse effects; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D057068:Periprosthetic Fractures / Q000209:etiology; D012189:Retrospective Studies