Long versus short intramedullary nails for trochanteric HIP fractures: a secondary analysis of the insite trial
Abstract
We aimed to use data from a recent randomized controlled trial (RCT) comparing the sliding hip screw vs. intramedullary nailing for trochanteric fractures to examine complication rates between those managed with a short vs. long nail.
This is a secondary analysis using one arm of an RCT that included ambulatory patients ³18 years with AO type 31-A1 or 31-A2 trochanteric fractures. We examined differences in fracture-related (femoral shaft fracture, implant failure, surgical site infection, nonunion, limb shortening, and pain) and medical adverse events (AE, organ failure, respiratory distress, stroke, deep vein thrombosis [DVT] gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection [UTI]), and readmission between those managed with a short vs. long IMN. We used logistic regression to examine the independent association between nail length and outcomes.
We included 412 trochanteric fracture patients managed with an IMN. Of these, 339 (82.2%) received a short (170mm-200mm) nail, while 73 (17.7%) received a long (260mm-460 mm) nail. Patients managed with a short nail were more likely to be admitted from an institution (vs. home), while those managed with a long nail were more likely to have comorbidities, and more complex fracture types.
Patients in the long nail group had higher rates of fracture-related AE (12.3%) vs. the short IMN group (3.5%). Specifically, the unadjusted rates of surgical site infection (SSI) and pain were…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 412 participants or records.
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