{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:05:22Z","timestamp":1789635922442,"version":"4.0.0"},"reference-count":22,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Posterior sagging (PS) of the proximal fragment after cephalomedullary nailing (CMN) of intertrochanteric fractures leads to loss of anteromedial cortical support. Methods: We retrospectively reviewed 118 patients with AO\/OTA 31-A2 intertrochanteric fractures (2007 classification). After an institutional protocol change, standard-length constructs with one distal screw were used until March 2019 (n = 65) and long constructs (\u2265300 mm) with two distal screws from June 2019 (n = 53); the cohorts were consecutive, not concurrent. Results: PS occurred in 23\/118 patients (19.5%): 21\/65 (32.3%) with standard-length versus 2\/53 (3.8%) with long constructs (p &lt; 0.001; adjusted odds ratio (OR) 0.08, 95% confidence interval (CI) 0.02\u20130.37). With standard-length constructs, PS was more frequent with big lesser trochanteric (LT) fragments (42.9% vs. 13.0%, p = 0.014); the interaction was not significant (p = 0.092). Long-construct use and a higher reduction score were associated with lower odds of PS, and older age and a big LT fragment with higher odds. Greater trochanter (GT) separation was present in 114 of 118 fractures and could not be evaluated as a risk factor. Conclusions: PS was associated with the standard-length construct and, within this group, with a big LT fragment. Nail length, distal locking, and treatment era could not be separated, so these findings show an association, not a causal effect of nail length. Functional outcomes were not assessed.<\/jats:p>","DOI":"10.3390\/jcm15187208","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:03:17Z","timestamp":1789632197000},"page":"7208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Long Versus Standard-Length Cephalomedullary Nail Constructs with Posterior Sagging in Intertrochanteric Fractures with Posteromedial Comminution: A Retrospective Comparative Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Jun-Young","family":"Heu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Incheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyeong-gu, Incheon 21431, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8467-1957","authenticated-orcid":false,"given":"Se-Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8468-7046","authenticated-orcid":false,"given":"Ju-Yeong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, College of Medicine, Gyeongsang National University, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1007\/s00402-015-2206-x","article-title":"Fracture reduction with positive medial cortical support: A key element in stability reconstruction for the unstable pertrochanteric hip fractures","volume":"135","author":"Chang","year":"2015","journal-title":"Arch. 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