Long proximal femoral nail vs Short proximal femoral nail for fixation of Trochanteric Fractures Which one is better? Results of a prospective cohort study.

Abstract

Background: There is a paucity of studies comparing the functional outcome, the difference in radiological union status, and the incidence of anterior thigh pain between short and long proximal femoral nails in the management of intertrochanteric fractures. We hypothesized that short nail with nail tip touching the anterior cortex would cause thigh pain and decreased functional outcome. Materials and Methods: This was a prospective non-randomized study of 75 patients with intertrochanteric femur fracture treated at a tertiary care center with long or short proximal femoral nail over a period of two years. Functional outcome assessment at 12 months after the surgical procedure was done using the Modified Harris Hip Score. Patients were evaluated for anterior thigh pain and union status was evaluated using serial radiographs at one month, three months, six months, and 12-month post-surgery. Results: Out of 75 cases included, 52% of patients (n=39) were operated with a short nail and 48%(n=36) were operated by using a long nail. There were 38 male and 37 female patients with a mean age of 67 years (range: 38 to 86 years). The mean operative time, blood loss in the short nail group was significantly shorter than that in the long nail group. There was no statistical difference in the union rate of fracture and duration of stay between the groups. At the final follow-up, the mean modified Harris hip score for the short nail group was 79.7, and that for long nail was 82.1. Fifteen patients in the short nail group reported having anterior thigh pain at a six-month follow-up. Conclusion: Short proximal femoral nail has a significantly higher incidence of anterior thigh pain which was troublesome for the patient even at 12-month follow-up and the surgeon should consider the variable anterior bowing of the femur before using a short nail.