{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:39:10Z","timestamp":1787755150667,"version":"build-2784847793"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Subtrochanteric hip fractures present a treatment challenge due to their varied etiologies, complexity, and associated complications. While intramedullary nailing is the standard treatment, the choice between short and long nails remains controversial. The aim of this meta-analysis was to compare the complication rates of short versus long cephalomedullary nail fixation in the treatment of subtrochanteric hip fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, and CINAHL databases were searched for relevant studies up to May 2025. Inclusion criteria comprised studies directly comparing short and long nails in treating subtrochanteric fractures, including randomized controlled trials and comparative studies. Data synthesis and statistical analysis were performed using RevMan 5.23.5 software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After screening, 5 retrospective comparative studies met the inclusion criteria, encompassing a total of 4,384 subtrochanteric fracture subjects. The weighted mean age was 82 years, with women representing 70.7% of the sample. Implant failure (odds ratio [OR] 2.12; 95% confidence interval [CI] [1.15-3.92]; p = 0.02) and peri-implant fractures (OR 4.03; 95% CI [1.46-11.14]; p = 0.007) were significantly more common with short nails. The reoperation rate was higher with short nails but not statistically significant (OR 1.33; 95% CI [0.87-2.04]; p = 0.19). No significant differences were observed between groups for nonunion (OR 0.96; 95% CI [0.40-2.33]; p = 0.94), deep infection (OR 0.70; 95% CI [0.23-2.17]; p = 0.40), or 1-year mortality (OR 0.83; 95% CI [0.43-1.58]; p = 0.57).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The use of short nails in the management of subtrochanteric hip fractures is associated with higher rates of implant failure and peri-implant fractures, with equivalent rates of nonunion, infection, 1-year mortality, and reoperation. These findings highlight the need for a well-conducted trial to assess the overall benefits and to determine the lowest level of subtrochanteric fracture that can be safely treated with short nails.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.25.00144","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:00:34Z","timestamp":1760032834000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Short Versus Long Nails in Treating Subtrochanteric Hip Fractures"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0174-6934","authenticated-orcid":false,"given":"Amr","family":"Selim","sequence":"first","affiliation":[{"name":"Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom"},{"name":"Cairo University, School of Medicine, Cairo, Egypt"},{"name":"School of Medicine, Keele University, Staffordshire, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5492-0780","authenticated-orcid":false,"given":"Nikhil","family":"Ponugoti","sequence":"additional","affiliation":[{"name":"North Tees and Hartlepool NHS Foundation Trust, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6722-5405","authenticated-orcid":false,"given":"Deepak","family":"Menon","sequence":"additional","affiliation":[{"name":"Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom"},{"name":"School of Medicine, Keele University, Staffordshire, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8737-1394","authenticated-orcid":false,"given":"Geraint","family":"Thomas","sequence":"additional","affiliation":[{"name":"Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom"},{"name":"School of Medicine, Keele University, Staffordshire, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10]]},"reference":[{"key":"R2-20251009","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s42836-019-0009-1","article-title":"Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors","volume":"1","author":"Hwang","year":"2019","journal-title":"Arthroplasty"},{"issue":"1","key":"R3-20251009","doi-asserted-by":"crossref","first-page":"18718","DOI":"10.1038\/s41598-019-55196-6","article-title":"One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study","volume":"9","author":"Morri","year":"2019","journal-title":"Sci Rep."},{"issue":"3","key":"R4-20251009","doi-asserted-by":"crossref","first-page":"540","DOI":"10.3390\/jcm10030540","article-title":"Mortality and medical complications of subtrochanteric fracture fixation","volume":"10","author":"Panteli","year":"2021","journal-title":"J Clin Med."},{"issue":"2","key":"R5-20251009","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1302\/2058-5241.6.200048","article-title":"Subtrochanteric femur fractures: current review of management","volume":"6","author":"Garrison","year":"2021","journal-title":"EFORT Open 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Does the cephalomedullary nail length matter?","volume":"35","author":"Gonzalo","year":"2025","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"5","key":"R20-20251009","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.otsr.2017.04.003","article-title":"Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review and meta-analysis","volume":"103","author":"Zhang","year":"2017","journal-title":"Orthop Traumatol Surg Res"},{"issue":"4","key":"R21-20251009","first-page":"373","article-title":"Short versus long intramedullary nails for intertrochanteric hip fracture: meta-Analysis","volume":"68","author":"Domenech","year":"2024","journal-title":"Rev Esp Cir Ortop Traumatol."},{"issue":"4","key":"R22-20251009","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00590-014-1557-2","article-title":"Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up","volume":"25","author":"Vaughn","year":"2015","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"2","key":"R23-20251009","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.injury.2021.11.064","article-title":"Biomechanical performance of short and long cephalomedullary nail constructs for stabilizing different levels of subtrochanteric fracture","volume":"53","author":"Chantarapanich","year":"2022","journal-title":"Injury"},{"issue":"11","key":"R24-20251009","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1016\/j.injury.2019.08.014","article-title":"Effect of fracture levels on the strength of bone-implant constructs in subtrochanteric fracture models fixed using short cephalomedullary nails: a finite element analysis","volume":"50","author":"Jang","year":"2019","journal-title":"Injury"},{"issue":"7","key":"R25-20251009","doi-asserted-by":"crossref","first-page":"e0253862","DOI":"10.1371\/journal.pone.0253862","article-title":"Biomechanics of subtrochanteric fracture fixation using short cephalomedullary nails: a finite element analysis","volume":"16","author":"Kwak","year":"2021","journal-title":"PLoS One"},{"issue":"10","key":"R26-20251009","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/BOT.0000000000001553","article-title":"Short versus long cephalomedullary nails for pertrochanteric hip fractures: a randomized prospective study","volume":"33","author":"Shannon","year":"2019","journal-title":"J Orthop Trauma"},{"issue":"2","key":"R27-20251009","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.berh.2019.03.015","article-title":"Interdisciplinary care of hip fractures.: orthogeriatric models, alternative models, interdisciplinary teamwork","volume":"33","author":"Ranhoff","year":"2019","journal-title":"Best Pract Res Clin Rheumatol."},{"issue":"1","key":"R28-20251009","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0134.R1","article-title":"Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations","volume":"99-B","author":"Socci","year":"2017","journal-title":"Bone Jt J"},{"issue":"14","key":"R29-20251009","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.2106\/JBJS.O.00229","article-title":"The American Academy of orthopaedic Surgeons Evidence-Based Guideline on management of hip fractures in the elderly","volume":"97","author":"Brox","year":"2015","journal-title":"J Bone Joint Surg Am"},{"key":"R30-20251009","doi-asserted-by":"crossref","first-page":"d3304","DOI":"10.1136\/bmj.d3304","article-title":"Management of hip fracture in adults: summary of NICE guidance","volume":"342","author":"Ftouh","year":"2011","journal-title":"BMJ"}],"container-title":["JBJS Open Access"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00144","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:38:23Z","timestamp":1787751503000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.OA.25.00144"}},"subtitle":["A Systematic Review and Meta-analysis of Complication Rates"],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.oa.25.00144","relation":{},"ISSN":["2472-7245"],"issn-type":[{"value":"2472-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}