Unstable Intertrochanteric Femoral Fracture in Elderly Patients: A Randomized Controlled Study of Failure Rate After Short Versus Long Cephalomedullary Nail

Background
Fixation of intertrochanteric femur fractures can be achieved using short or long cephalomedullary nails (CMNs), yet the optimal choice remains debated. This study compares short and long CMNs regarding postoperative ambulatory outcomes and failure rate.
Patients and Methods
A randomized controlled clinical trial was conducted on 70 elderly patients (aged 60–75 years) with unstable intertrochanteric fractures. The mean age was 68.2±4.42 years in the short nail group and 68.17±4.56 years in the long nail group. Male representation was 45.71 and 42.85%, respectively. Postoperative outcomes were assessed using the visual analog scale and Harris hip score.
Results
Complication rates, including cut-out, infection, ipsilateral fractures, and implant failure, were statistically similar in both groups. Visual analog scale scores at 3, 6, and 12 months showed no significant differences. Harris hip score at 3 and 6 months was significantly higher in the short nail group (P<0.001), while no significant difference was observed at 12 months. Operative time and infection-related outcomes were comparable across groups.
Conclusions
Short CMNs demonstrated shorter operative times and faster functional recovery compared with long CMNs. While both designs had similar complication and failure rates, short CMNs are promising devices for managing unstable intertrochanteric fractures, offering favorable outcomes with proper patient selection and care.