Short intramedullary nails performed better than long ones for peri trochanteric fractures: study

There is no consensus of whether to use a short or long intramedullary nail (IMN) in the treatment of trochanteric and subtrochanteric fractures.In the retrospective cohort study, Peter Sverre Frønsdal et al analyzed 17,606 trochanteric and subtrochanteric fractures treated with an IMN registered in the Norwegian Hip Fracture Register from 2008 to 2022. The primary outcome was overall 1-year reoperation risk, and secondary outcomes were reoperation risk for specific causes and 1-year mortality for short IMNs (SIMNs) and long IMNs (LIMNs) and to compare 1-year reoperation risk for short and long versions of the 2 most used brands (Gamma3 and TRIGEN INTERTAN). Cox regression analyses adjusted for age, sex, and ASA class and instrument variable (IV) analyses with operation year and hospital as instrument were performed to calculate hazard rate ratios (HRRs). The article has been published in ‘JBJS Open Access.’
The key findings of the study were:
• LIMNs had a statistically significant higher reoperation risk than SIMNs in A1 fractures in the IV analysis.
• No other statistically significant differences in overall 1-year reoperation risk or 1-year mortality between SIMNs and LIMNs were found for any of the fracture types.
• Infection was a more frequent cause of reoperation after LIMNs (HRR, 2.82 [95% confidence interval [CI], 1.53-5.20]) while peri-implant fractures were less common for LIMNs (HRR, 0.38 [95% CI, 0.200.75]) compared with SIMNs.
• No statistically significant differences were found in reoperation risk between short and long Gamma3 nails or TRIGEN INTERTAN nails.
The authors concluded – “For AO/OTA A1 fractures, LIMNs had a statistically significant higher risk of reoperation compared with SIMNs. Otherwise, no statistically significant differences in all-cause reoperation risk or mortality between short and long intramedullary nails in the treatment of different types of trochanteric and subtrochanteric fractures were found. Based on this registry-based study, a SIMN seems to be a safe treatment option also for fractures with unstable patterns. However, the role of SIMNs for trochanteric and subtrochanteric fractures with distal extension should be further investigated.”
Level of Evidence: Therapeutic Level III.Further reading:
Comparison of Short and Long Intramedullary Nails in the Treatment of Trochanteric and Subtrochanteric Fractures
Peter Sverre Frønsdal et al
JBJS Open Access 2025:e25.00015.
http://dx.doi.org/10.2106/JBJS.OA.25.00015