Quality differences in multifragmentary pertrochanteric fractures [OTA 31A2.2 and 31A2.3] treated with short and long cephalomedullary nails. Issue 7 (July 2022)

• Record Type: Journal Article
• Authors: Parola, Rown; Maseda, Meghan; Herbosa, Christopher G; Konda, Sanjit R.; Ganta, Abhishek; Egol, Kenneth A.
• Is Part Of: Injury. Volume 53:Issue 7(2022)
• Page Start: 2600
• Page End: 2604
• Publication Date: 2022-07
• Subjects: Unstable intertrochanteric fracture -- Cephalomedullary nail -- Intramedullary nail -- Quality -- Value-based healthcare; MP Multifragmentary Pertrochanteric -- CMN Cephalomedullary Nail -- STTGMA Score for Trauma Triage in the Geriatric and Middle Aged; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.05.036
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Multifragmentary pertrochanteric fracture [AO/OTA 31A2.2 and 31A2.3] patients treated with short cephalomedullary nails (CMNs) had mean procedure cost savings of $2442.90 and mean total cost of admission savings of $5607.64 relative to those treated with long CMNs. Patients treated with long CMNs had increased rates of blood transfusion (52.2% vs 34.0%, p = 0.005), discharge to rehabilitation facilities (91.3% vs 80.3%, p = 0.030), and longer operative times (84.8 vs 52.2 min, p <0.001) relative to those treated with short CMNs. There were no differences in timing of radiographic healing, rates of readmission, nonunion, screw cut out, fixation failure, or peri‑implant fracture between fixation methods. Abstract: Objectives: This study compares demographics, outcomes, and costs of patients with similar multifragmentary pertrochanteric (MP) fracture patterns treated with either a short or long cephalomedullary nail (CMN) to determine treatment efficacy and value during hospital admission. Design: Retrospective cohort study. Setting: Level-1 trauma center. Patients: 384 patients who presented with a MP fracture [AO/OTA 31A2.2 and 31A2.3] at 1 of 3 hospitals within a single academic medical center. Intervention: Surgical treatment with either short or long CMN Main outcome measurements: Operative time, in-hospital complications, discharge disposition, procedural and total costs of admission. Results: Sixty-nine (18.0%) patients were treated with long CMNs compared to 315 patients treated with short CMNs. Patients treated with long CMNs had increased rates of transfusions of allogenic packed red blood cells (52.2% vs 34.0%, p = 0.005), discharge to rehabilitation facilities (91.3% vs 80.3%, p = 0.030), and had costlier hospital stays ($28, 632.50 vs $23, 024.86, p = 0.014) with longer (74.9 vs 52.3 min, p <0.001), costlier procedures and implants ($12, 090.31 vs $9, 647.41, p = 0.014) compared to patients treated with short CMNs. There were no differences in timing of radiographic healing, rates of readmission, nonunion, screw cut out, fixation failure, or peri‑implant fracture. Conclusions: Short and long CMNs are equally suitable implants for the most unstable intertrochanteric fracture patterns. Short CMNs correlate with reduced operative time and costs with non-inferior in-hospital complication rates, hospital quality measures, and less frequent rehabilitation facility discharges. Given the similar long-term outcomes demonstrated here and in the literature, this data suggests nail length selection should be driven more by cost and discharge considerations for MP fractures. Level of evidence: level III.