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Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures

Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, a...

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Autores principales: Womble, Tanner N., Kirk, Andrew, Boyle, Maxwell, Comadoll, Shea M., Su, Leon, Srinath, Arjun, Matuszewski, Paul Edward, Aneja, Arun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8893295/
https://www.ncbi.nlm.nih.gov/pubmed/35245250
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00322
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author Womble, Tanner N.
Kirk, Andrew
Boyle, Maxwell
Comadoll, Shea M.
Su, Leon
Srinath, Arjun
Matuszewski, Paul Edward
Aneja, Arun
author_facet Womble, Tanner N.
Kirk, Andrew
Boyle, Maxwell
Comadoll, Shea M.
Su, Leon
Srinath, Arjun
Matuszewski, Paul Edward
Aneja, Arun
author_sort Womble, Tanner N.
collection PubMed
description Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion. METHODS: A retrospective chart review of patients aged 65 years or older who underwent CMN for low-energy intertrochanteric femur fractures from 2010 to 2018 was undertaken. Patient demographic data, comorbidities, case duration, postoperative hospital length of stay (LOS), and laboratory data, including serum creatinine, hemoglobin, and hematocrit, were collected for analysis. The following outcome measures were compared: postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, postoperative AKI, 30-day hospital readmission, 30-day return to operating room, 30-day mortality, 1-year mortality, postoperative anemia (hemoglobin <7 g/dL), and blood transfusion. RESULTS: A total of 247 patients were analyzed (short = 48, intermediate = 39, and long = 160). No notable difference was observed in postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, mean total hospital LOS, mean postoperative hospital LOS, rate of postoperative AKI, 30-day readmission, 30-day return to operating room, 30-day mortality, or 1-year mortality. Patients receiving long nails had significantly higher rates of postoperative anemia (P = 0.0491), blood transfusion (P = 0.0126), and mean procedure length (P = 0.0044) compared with the two other groups. DISCUSSION: Patients receiving long nails had markedly higher rates of postoperative anemia and blood loss requiring blood transfusion with markedly longer mean procedure length than patients receiving short and intermediate CMNs. Long nails did not result in an increase in other complications evaluated.
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spelling pubmed-88932952022-03-07 Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures Womble, Tanner N. Kirk, Andrew Boyle, Maxwell Comadoll, Shea M. Su, Leon Srinath, Arjun Matuszewski, Paul Edward Aneja, Arun J Am Acad Orthop Surg Glob Res Rev Research Article Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion. METHODS: A retrospective chart review of patients aged 65 years or older who underwent CMN for low-energy intertrochanteric femur fractures from 2010 to 2018 was undertaken. Patient demographic data, comorbidities, case duration, postoperative hospital length of stay (LOS), and laboratory data, including serum creatinine, hemoglobin, and hematocrit, were collected for analysis. The following outcome measures were compared: postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, postoperative AKI, 30-day hospital readmission, 30-day return to operating room, 30-day mortality, 1-year mortality, postoperative anemia (hemoglobin <7 g/dL), and blood transfusion. RESULTS: A total of 247 patients were analyzed (short = 48, intermediate = 39, and long = 160). No notable difference was observed in postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, mean total hospital LOS, mean postoperative hospital LOS, rate of postoperative AKI, 30-day readmission, 30-day return to operating room, 30-day mortality, or 1-year mortality. Patients receiving long nails had significantly higher rates of postoperative anemia (P = 0.0491), blood transfusion (P = 0.0126), and mean procedure length (P = 0.0044) compared with the two other groups. DISCUSSION: Patients receiving long nails had markedly higher rates of postoperative anemia and blood loss requiring blood transfusion with markedly longer mean procedure length than patients receiving short and intermediate CMNs. Long nails did not result in an increase in other complications evaluated. Wolters Kluwer 2022-03-02 /pmc/articles/PMC8893295/ /pubmed/35245250 http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00322 Text en Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Womble, Tanner N.
Kirk, Andrew
Boyle, Maxwell
Comadoll, Shea M.
Su, Leon
Srinath, Arjun
Matuszewski, Paul Edward
Aneja, Arun
Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures
title Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures
title_full Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures
title_fullStr Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures
title_full_unstemmed Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures
title_short Comparison of Short, Intermediate, and Long Cephalomedullary Nail Length Outcomes in Elderly Intertrochanteric Femur Fractures
title_sort comparison of short, intermediate, and long cephalomedullary nail length outcomes in elderly intertrochanteric femur fractures
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8893295/
https://www.ncbi.nlm.nih.gov/pubmed/35245250
http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00322
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