What does this research mean for the field?

Long proximal femoral nails (PFN) result in fewer complications such as anterior thigh pain and re-fractures compared to short PFNs and trochanteric femoral nails (TFN) in treating intertrochanteric fractures, but are associated with increased blood loss, surgical time, and radiation exposure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate how nail length affects outcomes in patients with intertrochanteric fractures.

May 20, 2026Open Access

Does the Nail Length Effects the Outcome of Intertrochanteric Fractures?

Key Points

This research aims to evaluate how nail length affects outcomes in patients with intertrochanteric fractures.
Ninety patients with intertrochanteric fractures were randomized into three groups: TFN, short PFN, and long PFN.
Outcomes assessed included blood loss, transfusion needs, surgery duration, hospital stay, C-arm exposures, functional outcomes, and complications.
Group C (long PFN) showed a mean blood loss of 131 ml versus 108 ml in Group A and 111 ml in Group B.
Mean Harris hip scores were highest in Group C at 91.2, while Group A had 86.3 and Group B 83.4, with P > 0.05 indicating no significant differences.
Long PFN had fewer complications such as anterior thigh pain and fractures compared to TFN and short PFN, despite higher blood loss and surgical time.

Abstract

Abstract Purpose: Intramedullary implants are preferred implants in the treatment of intertrochanteric fractures due to biomechanical advantages. Controversy exists regarding the effect of nail length on the outcome of these fractures. This study compares the outcome and complications of three types of cephalomedullary nails, i.e., trochanteric femoral nail (TFN; 180 mm), short proximal femoral nail (PFN) (250 mm), and long PFN (340–420 mm) in the treatment of intertrochanteric fracture. Materials and Methods: Ninety patients of intertrochanteric fractures of the femur were randomized into three groups and were treated with TFN (Group A), short PFN (Group B), or long PFN (Group C). Groups were compared for blood loss, need of blood transfusion, duration of surgery, hospital stay, number of C-arm exposures, functional outcome (modified Harris hip score), and associated complications (fracture, thigh pain, and re-operation rate). Results: Mean blood loss, need of blood transfusions, mean duration of surgery, and mean number of C-arm exposures in Group C (long PFN) were 131 ml, 7, 72 min, and 48.1 whereas in Groups A (TFN) and B (short PFN) were 108 ml, 6, 58 min, and 33.4 and 111 ml, 5, 61 min, and 36.8, respectively. In Groups A, B, and C, the mean union time was 11.6, 12.1, and 11.3 weeks and the mean Harris hip scores were 86.3, 83.4, and 91.2, respectively ( P > 0.05). The most common complication was anterior thigh pain seen in 2 and 8 patients of Groups A and B, respectively. Anterior unicortical hairline femur fracture distal to the tip of nail occurred in 3 patients in Group B. Two patients, each in Group B and in Group A, sustained re-fracture distal to the nail due to re-trauma. One patient of long PFN underwent implant removal for undergoing knee arthroplasty. Conclusion: Long PFN has proved to have lesser complications than TFN and short PFN with respect to anterior thigh pain, fractures, and re-operation rates but at the cost of higher blood loss, surgical time, and radiation exposure. Treatment of intertrochanteric fractures with respect to the nail length should be tailored depending on the patients’ profile and associated factors.

Does the Nail Length Effects the Outcome of Intertrochanteric Fractures?

Key Points

Abstract

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