LCN, SCN provide safe outcomes in osteoporotic pertrochanteric fractures
Both long (LCN) and short cephalomedullary nails (SCN) deliver safe and reliable outcomes in the treatment of osteoporotic pertrochanteric fractures, with no significant difference in terms of complications, revision surgeries, union rates and ambulatory statuses among patients, according to a Singapore study.
Researchers performed a retrospective review of 64 patients (mean age 79.9 years; 45 female; 38 had a left-sided hip injury) with osteoporotic pertrochanteric fractures who were treated with either LCN or SCN and had a minimum follow-up of 1 year. Based on the Orthopaedic Trauma Association (OTA) classification, 15 patients had OTA Class 31-A1 fractures and 49 had OTA Class 31-A2 fractures. All of the patients were osteoporotic, with an average T-score of ‒3.45 (range, ‒2.6 to ‒5.4).
Complications, revision surgeries and union rates were the primary outcome measures. Secondary outcome measures included duration of surgery, estimated blood loss, length of hospital stay, and ambulatory and mortality status at 1 year.
There were no significant differences in the clinical and functional outcomes of patients who were treated with LCN or SCN. However, those treated with SCN had a higher incidence of heterotopic ossification, while those who received LCN had a slightly higher average estimated blood loss and duration of surgery. In addition, patients treated with LCN appeared to be more osteoporotic. [Singapore Med J 2017; 58:85-91]
“This finding is in keeping with other studies in the literature,” researchers said. “For example, a study by Hou et al, which reviewed 283 patients who underwent either short or long cephalomedullary nail insertion for pertrochanteric fractures (ie, OTA Class 31-A1 and Class 31-A2 fractures), reported no significant difference in the complication or union rates between the two groups.” [J Orthop Trauma 2013;27:318-24]
No difference was also observed in the development of periprosthetic fractures between LCN and SCN despite the additional risk of periprosthetic fracture at the tip of short nails, particularly in osteoporotic bones. However, all three cases of periprosthetic fracture occurred in the SCN cohort. Of these, one case was fractured distal to the tip of the short nail, while the other two cases were fractured around the trochanteric region and the distal femur supracondylar region.
“Previous studies have hypothesised that short nails were more likely to create diaphyseal stress risers at the tip, causing periprosthetic fractures,” researchers said. “However, newer implants with better designs, such as lower modulus elasticity (eg, titanium), more anatomical femoral bow, tapered tips and smaller distal locking screws, have been developed to address this issue.” [J Bone Joint Surg Am 2009;91:712-9; J Bone Miner Res 1994;9:1137-41]
The current study was limited by its retrospective nature, the relatively smaller cohort of patients, lack of a longer-term follow-up and the results that were generated from a single centre, they added.
Osteoporosis is a condition that affects the global population, specifically women, and is associated with several complications such as hip fracture. Studies have projected that by 2050, potentially 50 percent of all hip fractures in the world will occur in Asia and Latin America, where osteoporosis is most prevalent. [Osteoporos Int 2006;17:1726-33; Osteoporos Int 1992;2:285-9]