Evaluate Intraoperative Variables and Postoperative Outcomes of Intertrochanteric Fractures with Vulnerable/Broken Lateral Wall Managed with Short and Long Cephalomedullary Nail

Abstract

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral wall managed with short and long cephalomedullary nail. Materials and Methods: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon’s perception of surgery. Functional outcome was assessed by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck shaft angle and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002) and surgeon’s perception of surgery (p=0.002) were significantly more in the LCMN group. The LCMN group had better functional outcome. HHS for the LCMN group was 89.15±9.53 and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group as compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modality for unstable intertrochanteric fractures with vulnerable/broken lateral wall and in the absence of larger study and long term follow up the superiority of one implant over the other cannot be recommended.