Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures

Richard W. Pectol, Matthew W. Kavolus, Axel Kiefer, Chandler R. Sneed, Tanner Womble, Jeffrey A. Foster, Daria L. Kinchelow, Gregory S. Hawk, Paul E. Matuszewski, David C. Landy, Arun Aneja

Research output: Contribution to journalArticlepeer-review


Purpose: It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0–24 h (h) and 24–36 h postoperative period. Methods: A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65 years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0–24 h and 24–36 h postoperatively. Results: 330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0–24 h (25.4% estimated mean increase, p value = 0.02) and 24–36 h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age. Conclusion: Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures. Level of evidence: Therapeutic level III.

Original languageEnglish
Pages (from-to)3135-3141
Number of pages7
JournalEuropean Journal of Orthopaedic Surgery and Traumatology
Issue number7
StatePublished - Oct 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.


  • Cephalomeduallary Nail
  • Elderly
  • Hip Fracture
  • Intertrochanteric Fracture
  • Opioids
  • Pain

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures'. Together they form a unique fingerprint.

Cite this