Does Size Matter for Cephalomedullary Nails in Geriatric Intertrochanteric Fractures?

Objectives: To evaluate the need for reoperation of geriatric intertrochanteric hip fractures treated with 10-mm cephalomedullary nails versus those treated with nails larger than 10 mm.

Design: Retrospective review at a single institution.

Setting: Level I trauma center.

Patients/participants: All patients age 60 and over treated with cephalomedullary fixation for an intertrochanteric femur fracture at a single institution.

Intervention: Cephalomedullary fixation with variable nail diameters.

Main outcome measurements: Reoperation rates of geriatric intertrochanteric fractures treated with a size 10-mm diameter cephalomedullary nail compared with patients treated with nails larger than 10 mm.

Results: There were no significant differences in reoperation rates when the 10-mm cohort was compared with an aggregate cohort of all nails larger than 10 mm (P = 0.99). This result was true for both all-cause reoperation and noninfectious reoperation. There was no difference between cohorts in regards to age, gender, or fracture pattern.

Conclusions: A 10-mm cephalomedullary nail can be used in lieu of a larger diameter fixation in patients age 60 and older with intertrochanteric femur fractures while still maintaining a comparable rate of reoperation.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.