Short versus long proximal femoral nail in the management of intertrochanteric fractures- a comparative study

Introduction: Intertrochanteric fractures are those that occur in the region spanning from the extracapsular basilar neck region to the region along the lesser trochanter proximal to the development of medullary canal. Low-energy falls account for 90% of fractures in people over the age of 50, with females having a higher prevalence. Intertrochanteric fractures in children and teenagers are caused by high-energy trauma. The aim of this study was to compare the functional and radiological outcomes as well as complications of intertrochanteric fractures treated with long proximal femoral nail (PFN) versus short proximal femoral nails. Methods: The study was a clinical randomized prospective comparative study which included 30 (2 groups of 15 patients each, being treated with short and long PFNs respectively) skeletally mature patients with fresh (less than 3 weeks old) intertrochanteric fractures of femur AO/OTA 31-A1, AO/OTA 31-A2 or AO/OTA 31-A3 as per AO/OTA classification. Harris Hip score was used to compare the functional outcomes. Results: The average age of patients in short PFN group (Group A) was 62.1 +/- 15.77 years and in long PFN group (Group B), it was 54.1 +/- 10.8 years. Male-female ratio in the study was 1.7:1. AO31A2 of AO fracture classification was the most common type of fracture in both the groups. The mean injury to surgery interval in Group A was 9.6 +/- 4.45 days and in Group B, it was 6 +/- 4.12 days. The mean operative duration in Group A was 68.6 +/- 6.62 minutes and in Group B, it was 78.6 +/- 7.35 minutes. The average time of union in Group A was 15.69 +/- 2.72 weeks while that of Group B was 15.77 +/- 2.05 weeks. The average Harris Hip score at final follow up in Group A was 81.0 +/- 11.62 and in Group B, it was 80.3 +/- 10.83. There was 1 case of implant failure in each group, which were re-operated. One case of screw back-out in Group A led to a varus collapse and had to be reoperated. One case of non-union was reported in Group B. One case of superficial wound infection was reported in each group. Conclusion: The Proximal Femur Nail can be used as an efficient implant to manage per trochanteric fractures regardless of the length of the implant. However, the mean operative time was found to be lower when a short nail is used.