Effect of Intramedullary Nail Length on Recovery after Geriatric Subtrochanteric Fractures: A Retrospective Cohort Study

Introduction:
Subtrochanteric femoral fractures in the elderly population are commonly treated with intramedullary nails. Traditionally these fractures were treated with long nails, but In recent years the use of medium length nails (200-235 mm) has been increasing, as they offer the advantage of a shorter surgery, and they do not often require reaming. This study compared patients with long and medium length nails with regards to fracture healing, revisions and complications.

Methods:
We analyzed all consecutive cases of low energy subtrochanteric fractures treated surgically at our institution between January 2018 and November 2020, and patient receiving medium (n=25) vs. long nails (n=45) were compared with regards to length of stay, time to painless ambulation, time to radiographic union and revision rate. Fracture severity was examined using the Seinsheimer classification.

Results:
Length of stay was shorter (9.3 medium vs. 11.5 days long, P=0.16) and rate of complications was lower (8% medium vs. 15% long, P=0.36) in the medium nail length group. Time to union (7.5 vs. 7.8 months) was almost identical (P=0.68). Time to painless ambulation was shorter in the medium length group (4.3 vs 6.95 months; p < 0.05). No difference in revision rate was found. Nail length choice was not influenced by the severity of the fracture (p>0.05).

Conclusions:
This study shows that use of medium length nails for subtrochanteric fractures allows shorter time to painless ambulation and has a similar rate of complications and revisions. Therefore, they may be considered a reliable substitute for traditional long nails for fixation of subtrochanteric fractures.