Cephalomedullary Nailing of Unstable Geriatric Intertrochanteric Fractures on a Traction Table Combined with Percutaneous Reduction Techniques is Safe and Results in a Low Rate of Cut-out.

Abstract

To describe a reproducible technique for reduction assessment and percutaneous reduction of unstable intertrochanteric fractures treated with a cephalomedullary nail on a traction table. Retrospective cohort study. Level-1 trauma center. Two-hundred twenty consecutive patients with intertrochanteric fractures. Initial closed reduction performed on a traction table. Accessory incisions were used to facilitate a reduction in 77 patients (35%). All fractures were stabilized with a cephalomedullary nail. Radiographic outcome including union, cut-out and fracture collapse (FC). Surgical outcomes including infection and hematoma were also reported. Mechanical complications (nonunion, cut-out and varus collapse) occurred in 8.8% of patients at one year. Eleven of 13 patients that developed these complications had either sub-optimal implant placement (tip-to-apex distance > 25 mm) or a varus reduction. There was no difference in the incidence of reoperation, nonunion, lag screw cutout, or posttraumatic arthritis based on the use of an accessory incision for fracture reduction. There was a significant increase in FC in patients who received an accessory incision (6.8 mm vs. 5.4 mm, p=0.04). One patient (1%) developed a hematoma in the accessory incision cohort, and one patient (0.7%) that did not have an accessory incision developed a postoperative infection. The current study suggests utilization of accessory incisions assist in reduction is safe and is associated with a low rate of complications. The surgeon should prioritize fracturereduction and optimal implant placement and not hesitate to utilize an accessory incision to assist with fracture reduction. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.