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IT hip Fractures – Long is the Only Way to Treat!

Learn why using long nails for hip fractures is the best choice, preventing failure, improving success rates, and reducing risks. Expert tips and comparisons provided.

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IT hip Fractures – Long is the Only Way to Treat!

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  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. 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, OTADepartment has received funds for educational support from Smith & Nephew, Zimmer, Synthes, Stryker I have no potential conflicts with this presentation

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

  4. Intertrochanteric Fracture • Classification AO/OTA Stable/Unstable dividing line www.jaaos.org

  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? http://olc.metrohealth.org

  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!

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