The selection of nail implant length for a specific patient is based on many factors including fracture location and stability, surgeon preference, and implant availability at the treatment facility or location. The distinction between short nails and long nails is confusing in that Synthes categorizes their 235 mm nail as “short” and Stryker categorizes their 240 mm nail as “long”. Each company’s product information categorizes nail lengths into either a short or long category ( Table 1). 29 Short nails are a fixed length, but long nails vary in length (typically 20 mm increments) as required by the patient’s femur length. The Depuy Synthes and Stryker companies occupy a significant share of the CMN market in the U.S. In addition to improvements in design over the years, multiple orthopaedic device companies have introduced CMN devices to market. The size of the distal interlocking screws also was decreased. Nails became smaller in diameter, transitioned from stainless steel to titanium, and were constructed to mimic more closely the anatomical anterior bow of the femur. 17 However, by the early 2000s, the increased risk of peri-prosthetic femoral shaft fractures associated with CMN devices was decreasing 10 as new nail modifications were introduced. long CMN implants revealed a lower post-operative peri-prosthetic fracture rate in the longer length CMN implants compared to the original, short-length nails. 24– 26 As a result, a new “long” nail was introduced to decrease stress concentration at the proximal femoral diaphysis and provide diaphyseal interference fit to the construct. 21, 23 However, the first generation of short-length nail implants was associated with a significantly increased risk of periprosthetic femoral shaft fracture as compared to SHS. 11– 14 When originally brought to market, CMNs possessed theoretical improved fracture fixation biomechanics compared to the SHS, 15 as well as the advantages of percutaneous insertion, which include less surgical exposure and blood loss, 16– 22 as well as earlier rehabilitation. Historically, intertrochanteric (IT) hip fractures were treated primarily with sliding hip screws (SHS), but after the introduction of the cephalomedullary nail (CMN) in the 1980s, the CMN quickly became the most common method of repair among orthopaedic surgeons in the U.S. ![]() 9, 10 Given the epidemiologic significance of hip fractures in the older adult population and its subsequent impact to the health care system, it is important that researchers continue investigating efficient and effective methods of hip fracture repair. each year, half of which are intertrochanteric fractures. 9 About 300,000 older adults are hospitalized with hip fractures in the U.S. will experience a hip fracture, with incidence increasing to 30% of women and 20% of men sustaining hip fractures by the age of 90. 8 Over the average lifespan of 80 years, approximately 10% of women and 6% of men in the U.S. ![]() 1– 6 Due to the increasing older adult population in the United States, 7 the incidence of hip fracture is expected to double by the year 2050. ![]() Hip fractures are recognized as a cause of significant morbidity and mortality in older adults.
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