Abstract
Purpose This study aimed to evaluate whether position of the displaced lesser trochanter affected clinical outcome in the treatment of unstable trochanteric fractures with intramedullary fixation. Patients and Methods Patients with unstable trochanteric fractures and displaced lesser trochanter who received intramedullary fixation were retrospectively reviewed in this study. Based on displacement distance of the lesser trochanter and whether the lesser trochanter was reduced operatively, patients were divided into three groups: patients with the displaced lesser trochanter less than 1cm (Group A), those with the displaced lesser trochanter more than 1 cm without operative reduction (Group B), or those with operative reduction (Group C). The surgical time, reduction quality, Harris Hip Score (HHS), Visual Analog Score (VAS), and complication rate were reviewed. Results There were 42 patients in Group A, 33 in Group B, and 36 in Group C with comparable demographic characteristics. The surgical time was significantly longer in Group C (P=0.009), compared with Groups A and B. Fracture reduction quality was comparable with over 85% good reduction among the three groups. The VAS score was significantly higher in Group B (P=0.023) without significant difference between Groups A and B. The HHS score was slightly lower in Group B, but it did not reach significant difference. The complication rate was statistically higher in Group B (p=0.043) than Groups A and C. Conclusion The severe displaced lesser trochanter may increase postoperative complications and postoperative pain in the treatment of unstable trochanteric femur fractures. However, the displaced lesser trochanter may not affect hip function.
Highlights
Hip fractures are a leading cause of disability among the older adults
Compared with stable trochanteric fractures, higher complication rate and limited hip function may occur in the treatment of unstable trochanteric fractures, which are generally determined by posterolateral instability [5, 6] and comminution of the medial cortex [4, 7, 8]
We aimed to evaluate the influence of postoperative position of the displaced lesser trochanter on hip function and postoperative complications in the treatment of unstable trochanteric femur fractures with intramedullary fixation
Summary
Hip fractures are a leading cause of disability among the older adults. Trochanteric femur fractures are the most common type of hip fractures and affect an increasing portion of population [1,2,3]. Compared with stable trochanteric fractures, higher complication rate and limited hip function may occur in the treatment of unstable trochanteric fractures, which are generally determined by posterolateral instability [5, 6] and comminution of the medial cortex [4, 7, 8]. The surgical treatment of unstable trochanteric fractures is largely either intramedullary or extramedullary fixation [9, 10]. With regard to biomechanical property, no statistical differences are reported between intramedullary and extramedullary fixation in the treatment of unstable trochanteric femur fractures [11]. Approximately 70% surgeons primarily use intramedullary fixation in the treatment of trochanteric fractures and it has become the dominant choice in the United States [15]. Intramedullary fixation is gradually becoming the gold standard for unstable trochanteric femur fractures
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