Comparison of short intramedullary nail and long intramedullary nail for the treatment of reverse oblique intertrochanteric fractures in the elderly

Abstract

Objective To investigate the effect of short intramedullary nail and long intramedullary nail in the treatment of elderly patients with intertrochanteric fractures and provide clinical reference for the internal plants of the intertrochanteric fractures. Methods The clinical data of 47 elderly patients with intertrochanteric fractures treated in our hospital from December 2012 to November 2016 were retrospectively analyzed. Data were divided into short intramedullary nail (240 mm) and long intramedullary nail (300 mm above) groups according to different internal fixators, including 26 cases of long nail group, 21 cases of short nail group. The operation time, blood loss, blood transfusion, postoperative weight-bearing time, fracture healing time, postoperative complications, hip function recovery, daily living ability score in accordance with Harris score were observed to access the patient's functional ability. Results Five patients died within one year after surgery due to accidental and cardiovascular diseases, which were not related to the fracture. Among them, 3 were in the long intramedullary nail group and 2 were in the short intramedullary nail group. The rest o were followed up for 1 years, the follow-up rate was 85.1%. In terms of operation time, blood loss and blood transfusion, the operation time [(33.5±1.04) min], blood loss [(192.5±5.2) ml], and blood transfusion [(191.8±115.6) ml] in the short intramedullary nail group were significantly less than those in the long intramedullary nail group. The difference was statistically significant (t=0.018, t=0.004, t=0.001, P<0.05). The postoperative weight-bearing time [(8.3±2.8) d], Harris score [(81±3) points], and fracture healing time [(14.5±2.1) w] in the short intramedullary nail group have no significant difference compared with the long intramedullary nail group [(8.4±2.2) d, (80±4) points, (14.8±2.7) w]. There is no postoperative incision infection or nonunion, fracture nonunion, deep venous thrombosis of lower extremity, hip varus, internal fixation loosening and internal fixation of the surrounding fractures. Conclusion For the aged femur intertrochanteric fracture, the time of operation, the amount of bleeding and the amount of blood transfusion in the treatment of the short intramedullary nail are better than that of the long intramedullary nail, and there is no middle pants effect and short intramedullary nail is recommended. Key words: Hip fractures; Fracture fixation, intramedullary; Aged