Short versus Long Cephalomedullary Nails for AO/OTA ۳۱-A۳ Reverse-Obliquity Intertrochanteric Femoral Fractures: A Focused Systematic Review

Objective: To synthesize the A۳-specific clinical and biomechanical evidence comparing short and long cephalomedullary nails and to determine whether current evidence supports routine use of a long nail. Methods: A focused systematic review was performed using PubMed/MEDLINE through August ۲۰۲۶, supplemented by backward citation screening Results: Six reports formed the core synthesis: four clinical reports and two A۳-specific biomechanical studies. In the most direct comparative clinical cohort (۱۷۰ patients), short and long nails had similar radiographic healing, non:union:, reoperation, readmission, and mortality; short nails were associated with lower blood loss (۱۱۱.۲ vs ۱۷۶.۷ mL), lower transfusion use (۳۷% vs ۵۵%), and shorter procedures (۱۱۸.۷ vs ۱۴۹.۰ min). Larger reverse-obliquity cohorts published subsequently found no consistent outcome advantage for long implants and recommended short implants when sufficient working length and acceptable reduction are achievable. One cadaveric A۳ model found similar overall construct stiffness with a short PFNA when the fracture remained ۲ cm proximal to the distal locking screw, whereas a synthetic A۳.۳ model demonstrated greater varus-related angular change with the shortest nail than with mid- or long-length nails. Conclusion: Current clinical evidence is modestly favorable to short cephalomedullary nails for appropriately selected AO/OTA ۳۱-A۳ fractures because major healing and revision outcomes appear comparable while operative burden is lower. Routine long-nail use is not supported for every A۳ fracture. Mid- or long-length implants remain reasonable when distal fracture extension, severe A۳.۳ morphology, displacement, or inadequate short-nail working length creates biomechanical concern. Reduction quality and cortical support remain critical determinants of success.

کلیدواژه ها:

AO/OTA ۳۱-A۳ ، reverse obliquity ، intertrochanteric fracture ، cephalomedullary nail ، Gamma nail ، short nail ، long nail ، working length