{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:51:46Z","timestamp":1787755906289,"version":"build-2784847793"},"reference-count":63,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"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>Despite extensive literature comparing short and long cephalomedullary nails (CMNs), the impact of CMN length on pulmonary complications in geriatric patients with intertrochanteric (IT) fractures is not well established. This study compared postoperative pulmonary complications in geriatric patients with IT fractures treated with short (&lt;235 mm) or intermediate (235-240 mm) CMNs (SINs) versus long (\u2265300 mm) CMNs (LNs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients aged \u226565 years with AO Foundation\/Orthopaedic Trauma Association (AO\/OTA) 31A1\u2013A3 fractures treated with SINs or LNs between 2008 and 2020 were retrospectively identified at a single Level 1 Trauma center. The primary outcome was inpatient postoperative pulmonary complications. Secondary outcomes included mortality, surgical duration, and other inpatient postoperative complications. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated using logistic regression to adjust for comorbidities (i.e., diabetes, hypertension, chronic) obstructive pulmonary disease, smoking status, age, AO\/OTA classification, ASA \u22653, time to surgery, and surgical duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 881 patients were treated with either an SIN (n = 327) or an LN (n = 554). The SIN group was older (80.7 \u00b1 9.1 years vs. 79.3 \u00b1 8.4 years, p = 0.016), had a higher proportion of AO\/OTA 31A1 fractures (p &lt; 0.001), and included more patients with ASA \u22653 (89% vs. 84%, p = 0.035). In the SIN group, the median surgical duration was shorter (60 [interquartile range (IQR): 47-79] vs. 81 minutes [IQR: 62-106], p &lt; 0.001), and rates of postoperative anemia (74% vs. 81%, p = 0.017) and transfusion (43% vs. 54%, p = 0.001) were lower. After adjusting for covariates, multivariable analysis demonstrated increased odds of postoperative pneumonia (AOR: 2.09, 95% CI: 1.01-4.71, p = 0.048), pulmonary embolism (AOR: 4.38, 95% CI: 1.09-29.5, p = 0.036), and transfusion (AOR: 1.38, 95% CI: 1.02-1.85, p = 0.034) in the LN group. There were no differences in mortality or other postoperative complications (p &gt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Geriatric patients with IT fractures treated with LNs had increased odds of inpatient postoperative pneumonia, pulmonary embolism, and transfusion. However, mortality and other postoperative complications were similar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\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.25.00170","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T18:00:32Z","timestamp":1758304832000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Increased Risk of Pulmonary Complications with Long Cephalomedullary Nails in Geriatric Intertrochanteric Femur Fractures"],"prefix":"10.2106","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4003-1149","authenticated-orcid":false,"given":"Maaz","family":"Muhammad","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3281-7491","authenticated-orcid":false,"given":"Griffin","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5976-8982","authenticated-orcid":false,"given":"Wyatt G. S.","family":"Southall","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3666-6287","authenticated-orcid":false,"given":"Adam N.","family":"Musick","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5741-9840","authenticated-orcid":false,"given":"Austin T.","family":"Gregg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7031-1643","authenticated-orcid":false,"given":"Robert K.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8935-9965","authenticated-orcid":false,"given":"Gregory S.","family":"Hawk","sequence":"additional","affiliation":[{"name":"Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1507-6863","authenticated-orcid":false,"given":"Arun","family":"Aneja","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7]]},"reference":[{"issue":"1","key":"R1-20250919","doi-asserted-by":"crossref","first-page":"e0045","DOI":"10.2106\/JBJS.OA.18.00045","article-title":"Incidence and economic burden of intertrochanteric fracture: a Medicare claims database analysis","volume":"4","author":"Adeyemi","year":"2019","journal-title":"JB JS Open Access"},{"issue":"8","key":"R2-20250919","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/jbmr.4821","article-title":"Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality","volume":"38","author":"Sing","year":"2023","journal-title":"J Bone Mineral Res."},{"issue":"6","key":"R3-20250919","doi-asserted-by":"crossref","first-page":"e50","DOI":"10.5435\/JAAOS-D-15-00325","article-title":"Nail length in the management of intertrochanteric fracture of the 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