1. IT hip Fractures – Long is the Only Way to Treat!
SEFS
Feb. 1st, 2019
Kyle J. Jeray
University of South Carolina, Greenville
Greenville, SC

2. I have no potential conflicts with this presentation
My disclosures –Editorial board OTAInternational, JOT and JBJS Am; Reviewer JBJS, JOT, JAAOS, HAND, CORR; Consultant for Zimmer, Radius; ABOS Oral Board Examiner; Chairman AOA/Critical Issues Committee; Research support from Department of Defense, CIRH, NIH, AO North America, OTA Department has received funds for educational support from Smith & Nephew, Zimmer, Synthes, Stryker

3. Objectives Anatomy and classification Treatment options
Only ONE correct choice!
Summary

4. Intertrochanteric Fracture
Classification AO/OTA
Stable/Unstable
dividing line

5. Audience Survey
Who routinely uses short nail vs long nail for unstable proximal Femur Fractures?
For stable IT fractures?
For ALL IT hip fractures?

6. Summary – THE BEST REASON
Always use long nails as it ELIMINATES poor physician decision regarding fracture types (avoids failure)!
Insures success in proximal femur fractures!

7. Long Nail – Tip to be happy Surgeon
Femoral Bow
Increases with age
deformity
Large radius of
curvature=Straighter nail
Smaller radius- more curved nail

8. Anterior perforation/impingement
Can Occur with both long and shorter nails

9. Long Nail – Tip to be happy Surgeon
Distal Interlocks
Don’t lock unless unstable
Biomechanical and clinical studies show benefit of distal interlocking to prevent failure and decrease peri-prosthetic fracture rate
Increased fluoro/OR time

10. Long Nail – Tip to happy Surgeon
Tip Apex Distance
SHS and IMN
<= 25 mm
Measure from tip to desired center-center location
IMN aim slightly low?

11. Long vs. Short Nail Protects the entire bone
Less refractures around implant!
Albeit small (in most studies) but a good reason!

12. Long vs. Short Nail
COST?
Really? Couple hundred of bucks more relative to cost of entire care!
Sorry not good enough

13. Long vs. Short Nail EBL Most studies a worthless measure
When looking at transfusions no difference!

14. Long vs. Short Nail Time? Really? On average 12 minutes longer
Does anybody care about 12 minutes?
THROW AWAY YOUR WATCH!

15. Long vs. Short Nail
CLEARLY MANY UNSTABLE FRACTURE PATTERNS NEED LONG NAIL!
So get good at one procedure which works ALL the time!

16. Long vs. Short Nail SCARE YOU INTO LONG NAILS!
Locking screw in short nail at risk for ARTIERIAL INJURY!!!!!!

17. Summary of Tips Tip Apex Distance less than 25 mm
Evaluate anterior bow
Lock Distally at least in unstable fractures

18. So Why Best Choice? Protect most/all of the bone
Lower periprosthetic fracture rate
EBL, time (12 min longer), cost - all of little difference
Eliminates decision making errors by MD!