The Extended-Short Nail System, a Novel Concept in the Management of Proximal Femur Fractures

In light of recent health care reform and the aging US Medicare popu­lation, it is becoming increasingly important for orthopedic surgeons to use effective and efficient strate­gies for hip fracture surgery.

The Extended-Short Nail System (ES nail) is a US Food and Drug Administration–approved titani­um nail which is locked at the same location as the locking hole of a short intramedullary (IM) nail. The ES nail takes advantage of an “extended-short” hybrid design combining the mechanical charac­teristics of a long IM nail with the surgical ease of use offered with a short IM nail.

We retrospectively studied the 2-year outcomes of the first 150 patients who underwent intertrochan­teric fracture fixation with ES nails. Fifty-four of the 93 patients (58.1%) available at 2 years had returned to prefracture level of activity (based on UCLA Activity Scale scores). There were 2 postoperative periprosthetic fractures, 2 wound infections, and 3 postoperative hematomas, but no nonunions, implant failures, cutouts, or fixation failures.

Our experience with the ES nail system—its ease of use, low com­plication rate, high union rate, and favorable rate of patients’ return to prefracture activity level—suggests it is a viable option in the manage­ment of hip fractures.