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

Autor:	Womble TN; From the University of Kentucky College of Medicine, Lexington, KY (Dr. Womble, Dr. Kirk, Mr. Boyle, and Mr. Su); the Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Comadoll); the Department of Orthopaedic Surgery (Dr. Srinath, Dr. Matuszewski, and Dr. Aneja); and the Department of Statistics, University of Kentucky, Lexington, KY. (Mr. Su)., Kirk A, Boyle M, Comadoll SM, Su L, Srinath A, Matuszewski PE, Aneja A
Jazyk:	angličtina
Zdroj:	Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews [J Am Acad Orthop Surg Glob Res Rev] 2022 Mar 02; Vol. 6 (3). Date of Electronic Publication: 2022 Mar 02.
DOI:	10.5435/JAAOSGlobal-D-21-00322
Abstrakt:	Introduction: 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. (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)
Databáze:	MEDLINE
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