Reamed Versus Unreamed Intertrochanteric Femur Fractures, Is It Time?

Objectives: This study compares the intraoperative and postoperative outcomes of the traditional technique of femoral canal reaming to placement of an unreamed 10-mm nail. Design: Retrospective cohort study. Setting: Academic Level I Trauma Center, Southeastern US. Patients/Participants: Intertrochanteric femur fractures treated with a CMN (January 2016-December 2018) were retrospectively identified. Inclusion criteria were as follows: low-energy mechanism, at least 60 years of age, and long CMN. Exclusion criteria were as follows: short CMN, polytrauma, and subtrochanteric fractures. Outcome Measurements: Records were reviewed for demographics, hematologic markers, transfusion rates, operative times, and postoperative complications. Variables were assessed with a chi(2)or Student T-test. Significance was set at 0.05. Results: Sixty-five patients were included (37 reamed and 28 unreamed), with a mean age of 76.2 years and mean body mass index of 25.1. Between the reamed and unreamed groups, respectively, mean nail size was 11.0 (SD 1.1) and 10.0 (SD 0.0),P< 0.001; mean blood loss was 209.1 mL (SD 177.5) and 195.7 mL (SD 151.5),P= 0.220; 55% (21/38), and 43% (12/28) were transfused,P= 0.319; operative time was 98.2 (SD 47.3) and 81.5 minutes (SD 40.7);P= 0.035. Changes in hemoglobin/hematocrit were not significant between the study groups. Two patients from the reamed group experienced implant failure due to femoral head screw cut out and returned to the operating room. Two patients from the unreamed group returned to operating room for proximal incision infection, without implant removal. One reamed patient and 2 unreamed patients died before 6-month follow-up. Conclusions: Unreamed CMNs for geriatric intertrochanteric femur fractures provide shorter operative times with no difference in perioperative complications. Both reamed and unreamed techniques are safe and effective measures for fixation of these fractures.