title: Is distal locking of long nails for intertrochanteric fractures necessary? A clinical study.
abstract: BACKGROUND
  Few clinical studies have examined the utility of distal interlocking nails when fixing intertrochanteric fractures with intramedullary devices. In this study we performed a retrospective analysis comparing fixation method of intertrochanteric fractures with either a long unlocked cephalomedullary nail versus a long locked cephalomedullary nail. Our hypothesis was there would be no difference in device related failures or complications in stable intertrochanteric fractures treated with long locked or long unlocked cephalomedullary nails.
  
  
  METHODS
  A retrospective chart review was performed of all stable intertrochanteric fractures treated with a long cephalomedullary nail between 2006 and 2012 at our institution. Clinical history as well as perioperative radiography was carefully reviewed for all subjects. AO classification, the use of locked or unlocked technique, and failure status was recorded.
  
  
  RESULTS
  Overall, a device related failure rate of 1.8% (2/107) was observed for stable intertrochanteric fractures treated with long cephalomedullary nails. No statistical difference in failure rate was found between locked and unlocked nails within our studied population (0% long locked (0/56) versus 3.9% long unlocked (2/51), p = 0.224).
  
  
  CONCLUSIONS
  This clinical study supports our hypothesis that long cephalomedullary nails do not need to be locked for stable intertrochanteric fractures. We found no difference in failure rates between the two approaches across 107 patients.
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Vopat
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kane
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Truntzer
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: McClure
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: David
authors.initials: D
authors.lastname: Paller
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Abbood
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University/Rhode Island Hospital, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Born
keywords: Cephalomedullary nails; Distal interlocks; Intertrochanteric fractures