Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (AO 31-A1 and AO 31-A2): a systematic review.

objectivesIntramedullary nails are used increasingly in the surgical treatment of intertrochanteric femur fractures (IFFs). However, controversy has developed regarding the length of the nail itself. The purpose of this study is to investigate differences in reoperation rate, as well as operating time, length of hospital stay and 1-year mortality between short and long intramedullary nails in IFF-type AO 31-A1 and AO 31-A2. DATA SOURCES: A search was conducted using PUBMED, Embase and Cochrane Central (January 1, 2000-August 1, 2018). Articles written in English, German or Scandinavian language were included. STUDY SELECTION: Studies with patients > 18 years having an IFF comparing short nail with long nail and a least one of the clinical outcomes on interest (reoperation rate, operating time, length of hospital stay, 1-year mortality) were included. DATA EXTRACTION: A total of 2680 studies were identified and screened according to PRISMA guidelines. Cochrane risk of bias tool for RCTs and non-randomized studies was used to assess the risk of bias. DATA SYNTHESIS: Odds ratio and 95% confidence interval were calculated.

conclusionsNo difference in complication rate leading to reoperation was found in the individual studies or in the meta-analysis [OR 0.89 (0.49; 1.16)]. There is no difference in the length of hospital stay between the two nail cohorts; a shorter operating time inserting a short nail compared to inserting a long nail was found (p < 0.0001). In the meta-analysis, we found no difference in 1-year mortality [OR 1.20 (0.80; 1.79)].