Short Versus Long Intramedullary Nails in the Treatment of Pertrochanteric Hip Fractures: Incidence of Ipsilateral Fractures and Costs Associated With Each Implant.
OBJECTIVE
Both short intramedullary nails (SIMNs) and long intramedullary nails (LIMNs) are routinely used in the surgical treatment of pertrochanteric hip fractures. The purpose of this study was to assess the incidence of ipsilateral femur fractures after the surgical treatment of hip fractures and the overall costs associated with each implant.


METHODS
Retrospective cohort study.


METHODS
Level I trauma center and 2 community hospitals.


METHODS
A total of 609 patients with pertrochanteric hip fractures treated with an SIMN or LIMN from 2005 to 2011.


METHODS
Review of patient demographics and clinical outcomes over a 5-year follow-up period.


METHODS
Ipsilateral femur refracture rates were recorded for both groups, and a cost analysis was then performed to compare SIMNs and LIMNs while accounting for their observed refracture rates and surgical/hospital costs to determine the overall cost of each implant.


RESULTS
Union rates were equivalent between groups and averaged over 97%. The incidence of ipsilateral femur fractures in both groups steadily increased with greater follow-up time to reach nearly 10% at 5 years. Although only 47% of all nails were locked distally, 15 of the 16 refractures occurred in nails that were not distally locked. Cost analysis revealed no significant difference in the use of short versus LIMNs over a 5-year period (P = 0.76).


CONCLUSIONS
The incidence of ipsilateral femur refractures steadily rose with greater follow-up in both SIMN and LIMNs. Distally locking the initial fixation seems to protect against future femur fractures and may also affect the refracture location when using LIMNs. No differences in overall costs were seen at 1, 2, or 5 years between SIMNs and LIMNs.


METHODS
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, UCSF Fresno, Fresno, CA.
Eric
E
Lindvall
Samia
S
Ghaffar
Armen
A
Martirosian
Lisa
L
Husak
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000145:classification / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005264:Femoral Fractures / Q000191:economics* / Q000453:epidemiology*; D005594:Fracture Fixation, Intramedullary / Q000191:economics / Q000295:instrumentation / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult