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· DOS Abstracts
Reoperation after long and short intra medullary nail
in patients with per- and subtrochanteric fracture.
Lasse Eriksen, Frederik Højsager, Katia Damsgaard Bomholt, Søren Overgaard,
Jens Lauritsen, Bjarke Viberg
Department of Clinical Research, University of Southern Denmark, Department
of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background:
Short (SIMN) and long Intramedullary Nails (LIMN) are frequently
used in the management of femoral pertrochanteric (Pfx) and subtrochanteric
fractures (Sfx) but the literature is scarce on the optimal choice regarding re-
operations. The motivation for use of LIMN in Pfx has been prophylaxis for new
fractures distal to a short nail.
Purpose / Aim of Study:
To compare reoperation proportions between SIMN
and LIMN in patients with Pfx and Sfx.
Materials and Methods:
From 2008–2013 data on 8.516 hip fractures in the
Region of Southern Denmark was retrieved from the Danish Multidisciplinary
Registry for Hip Fractures (DMRHF). 1.419 patients with the procedure codes
KNFJ51-52 were included. Data from DMRHF includes age, sex, Charlsons
Comorbidity Index (CCI), and reoperations within 2 years. All health records
were reviewed for type of IMN and fracture near the IMN (fxIMN). Proportions
of reoperation and crude and age/sex/CCI adjusted Odds Ratios (OR) from lo-
gistic regression comparing SIMN and LIMN are given with 95% Confidence in-
tervals.
Findings / Results:
There were 807 patients with Pfx and 612 with Sfx. The
median age was 84.8 years and 70.6% were female with no differences be-
tween groups. Pfx reoperation level for SIMN was 5.6% (3.7;8.0) (27/483 – 3
fxIMN) compared to 8.0% (5.3;11.5) (26/324 – 4 fxIMN) for LIMNs. Crude
OR = 1.47 (0.84;2.57), adjusted OR = 1.56 (0.89;2.74) comparing LIMN to
SIMN. Sfx reoperation level for SIMN was 10.8% (7.0;15.8) (23/213 – 5 fx-
IMN) compared to 6.0% (3.9;8.8) (24/399 – 2 fxIMN) for LIMN. Crude OR
= 0.52 (0.29;0.96), adjusted OR =0.49 (0.26;0.9) comparing LIMN to SIMN.
Conclusions:
This is the largest study to date showing no difference between
SIMN and LIMN for Pfx but an increased risk of reoperation for Sfx managed
with SIMNs. Thus there seems to be no indication for use of long nails in Pfx as
a routine.
No conflicts of interest reported
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