ARE SHORT NAILS EQUALLY AS EFFECTIVE AS LONG NAILS IN THE MANAGEMENT OF SUBTROCHANTERIC FEMORAL FRACTURES? A META-ANALYSIS

Subtrochanteric fractures present a challenge in treatment due to their varied aetiologies and complexities. Surgical intervention aims to alleviate pain and facilitate early mobility, but associated post-operative mortality remains considerable. The mortality further increases should a surgical complication occur, necessitating appropriate implant choice and surgical technique. While intramedullary nailing is the standard treatment, the choice between short and long nails remains contentious. This meta-analysis aims to compare the complication outcomes of short and long cephalomedullary nail (CMN) fixation for subtrochanteric hip fractures. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, and CINAHL databases were searched for relevant studies. Inclusion criteria comprised studies directly comparing short and long nails in treating subtrochanteric fractures, including Randomised Controlled Trials (RCTs) and comparative studies. Data synthesis and statistical analysis were performed using RevMan 5.23.5 software. After screening, three retrospective comparative studies met the inclusion criteria. This involved a total of 4097 subjects with subtrochanteric fractures, of whom 785 were treated with short nails and 3312 with long nails. The mean ages across the studies ranged from 78.9 to 83.2 years. Peri-implant fracture and implant failure were statistically higher in short nails, with p values 0.005 and 0.01, respectively. The overall reoperation rates, non-union, and deep infection weren't statistically different between both groups, with p values 0.55, 0.92, and 0.40, respectively. Our findings challenge previous recommendations favouring the use of short nails across all per-trochanteric hip fractures and suggest that long nails are safer than short nails for the subtrochanteric group, since they are associated with lower rates of implant failure and peri-implant fractures. This is the first meta-analysis to investigate the effect of nail length on the outcomes of subtrochanteric fractures among all proximal femoral fractures.