Difference In Quality Of Reduction Research Articles

A Cadaveric Study: Does Ankle Positioning Affect the Quality of Anatomic Syndesmosis Reduction?

The objective of this study was to compare the quality of syndesmotic reduction with the ankle in maximal dorsiflexion versus neutral plantarflexion (normal resting position). Baseline computed tomography (CT) imaging of 10 cadaveric ankle specimens from 5 donors was obtained with the ankles placed in normal resting position. Two fellowship-trained orthopaedic surgeons disrupted the syndesmosis of each ankle specimen. All ankles were then placed in neutral plantarflexion and were subsequently reduced with thumb pressure under direct visualization through an anterolateral approach and stabilized with one 0.062-inch K-wire placed from lateral to medial in a quadricortical fashion across the syndesmosis. Postreduction CT scans were then obtained with the ankle in normal resting position. This process was repeated with the ankles placed in maximal dorsiflexion during reduction and stabilization. Postreduction CT scans were then obtained with the ankles placed in normal resting position. All postreduction CT scans were compared with baseline CT imaging using mixed-effects linear regression with significance set at P < 0.05. Syndesmotic reduction and stabilization in maximal dorsiflexion led to increased external rotation of the fibula compared with baseline scans [13.0 ± 5.4 degrees (mean ± SD) vs. 7.5 ± 2.4 degrees, P = 0.002]. There was a tendency toward lateral translation of the fibula with the ankle reduced in maximal dorsiflexion (3.3 ± 1.0 vs. 2.7 ± 0.7 mm, P = 0.096). No other statistically significant differences between measurements of reduction with the ankle placed in neutral plantarflexion or maximal dorsiflexion compared with baseline were present (P > 0.05). Reducing the syndesmosis with the ankle in maximal dorsiflexion may lead to malreduction with external rotation of the fibula. There was no statistically significant difference in reduction quality with the ankle placed in neutral plantarflexion compared with baseline. Future studies should assess the clinical implications of ankle positioning during syndesmotic fixation.

Surgical approach of T-type acetabular fractures does not affect quality of reduction on postoperative CT or the likelihood of postoperative complications

IntroductionT-type acetabular fractures are rare but challenging injuries. The purpose of this study was to evaluate for associations between chosen surgical approach for T-type acetabular fracture fixation, reduction quality, and complications. MethodsRetrospective, single institution study of T-type acetabular fractures who underwent surgical fixation. Surgical interventions included open reduction and internal fixation (ORIF) through an anterior intrapelvic approach (AIP) (modified Rives-Stoppa) and/or posterior (Kocher-Langenbeck [KL]), or percutaneous screw fixation. The primary outcome was reduction quality on routine postoperative computed tomography (CT) scan and postoperative complications. ResultsDuring the study period (March 2016 – October 2022), 22 patients presented with T-type acetabular fractures. Surgical approaches included AIP [31.8% (7/22)], percutaneous [27.3% (6/22)], AIP+KL [22.7% (5/22)], and KL [18.2% (4/22)]. On CT scans, 9.0% (2/22) had anatomic reductions, 27.2% (6/22) had fair reductions, and 63.6% (14/22) had poor reductions based on Matta Reduction Criteria. There was no observed difference in reduction quality between surgical approaches. Poor reductions (> 3 mm) were not associated with surgical approach, fracture classification, unstable pelvic ring injuries, posterior wall fractures, T-stem component, transverse component, preoperative articular displacement, preoperative femoral head protrusion, or surgeon experience. Complications occurred in 50.0% (11/22) of patients. No observed difference in complication rates was noted between the surgical approaches. ConclusionT-type acetabular fractures are challenging injuries with few patients achieving anatomic reduction on postoperative CT scans and half of patients developing complications.

Efficacy and safety of pararectus approach for the treatment of acetabular fractures: A systematic review and meta-analysis

BackgroundThe pararectus (PR) approach combines the advantages of the second window of the ilioinguinal approach and the medial view of the modified Stoppa approach. However, it is unclear whether the PR approach is more effective or safer than the other approaches, as few clinical studies have compared the PR approach with the other approaches. The aim of this study was to provide a systematic review and meta-analysis comparing the PR approach with the other approaches for the treatment of acetabular fractures and to answer the following question: Are the results of the PR approach superior to those of the other approaches in terms of reduction quality, operative time, operative blood loss, complications, and clinical outcomes for treatment of acetabular fractures? Patients and methodsA systematic literature review was conducted using relevant original studies from various databases. Pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value<0.05 was considered to be significant. We calculated the mean differences for continuous data and odds ratio for dichotomous data with 95% confidence intervals for each outcome. Statistical heterogeneity was assessed based on I2 using the standard χ2 test. ResultsFive studies were included in this meta-analysis. The findings demonstrated that operative blood loss was significantly lower in the PR approach than in the other approaches (p=0.04). There was no significant difference in the rate of anatomical reduction, the operative time, the rate of complications, and the rate of excellent or good clinical score between the PR approach and the other approaches. DiscussionThe PR approach provided lower operative blood loss, although there was no significant difference in reduction quality, operative time, complications, and excellent or good clinical score between the PR approach and the other approaches. Level of evidenceIII.

Reduction Quality of Open vs Percutaneous Techniques for the Posterior Malleolus

Category:Ankle; TraumaIntroduction/Purpose:Ankle fractures with posterior malleolar involvement are common. Fixation of the posterior malleolus (PM) in these injuries remains controversial & currently, there is no evidence to guide operative decision making for the PM. This study compares radiographic & clinical outcomes between percutaneous & open fixation techniques of the PM.Methods:All ankle fractures between 01/2010 & 01/2018 with surgical stabilization of the PM were reviewed from a level 1 trauma center. High-energy (i.e. pilon), open & pathologic fractures were excluded. Orthopaedic Trauma Association (AO/OTA) fracture pattern, PM articular surface comminution, incarcerated fragments & loose bodies were recorded based on pre-operative CT scans. Patients were either treated with direct reduction (DR) or percutaneous reduction (PR). Intra-operative & serial post- operative radiographs were used to measure PM articular reduction & graded as satisfactory (<2mm articular step-off) or poor (>2mm articular step-off). Medical records were reviewed for fixation technique & complications. Patient-reported outcomes measurement information system (PROMIS) scores were used to compare clinical outcomes. Univariate methods including x2, Fischer exact test, One-way ANOVA were used & a multivariate nominal logistic regression model was constructed to evaluate predictors of a satisfactory reduction.Results:A total of 120 patients (ages 19-84) were included. DR through an open approach was performed in 91 patients & PR in 29. The DR cohort had a higher rate of satisfactory reduction (92.3% vs 75.9%, p=0.04). Articular comminution was identified in 65 (50.4%) & this morphology had a higher rate of satisfactory reduction with ORIF (94% vs 66.6%, p=0.04). There was no difference in reduction quality for non-comminuted fractures treated open or percutaneously (90.2% vs 83.3%, p=0.64). Incarcerated fragments or loose bodies were identified in 58 (48.3%) of fractures. There was a trend for improved reduction quality in the DR group for this morphology (p=0.08). Multivariate analysis identified that open approach is associated with a satisfactory reduction (p=0.02). No difference in complication rate between groups or PROMIS scores (p>0.05) for 64 patients with average final follow up of 19 months (range 6-60 months) were found.Conclusion:This study demonstrates that DR of the PM via an open approach in low energy ankle fractures leads to improved radiographic outcomes compared to percutaneous techniques without a difference in complication rate. This study also highlights the utility of a pre-operative CT scan to better assess the morphology of the posterior malleolus as articular comminution, interposed fragments or loose bodies were common findings that are difficult to assess on plain radiographs & may alter surgical plan if present. However, no difference in PROMIS scores were seen between direct and percutaneous reduction techiniques.

Humerus trochlear angle (HTa)\u2014a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures

BackgroundThe supracondylar humerus fractures are the most common fracture in children’s elbows. Generally, close reduction and percutaneous pinning can provide satisfactory outcomes after adequate reduction. Baumann angle is commonly used to evaluate reduction quality, however, it may fail to assess reduction well when the elbow is in flexion and/or when the patient is young. We conducted this study to evaluate the potential value of the humerus trochlear angle (HTa) for the reduction evaluation and compare it with the Baumann angle.MethodsWe retrospectively reviewed supracondylar humerus fractures in our trauma center from 2016 to 2019. Patients were grouped as followed: in the HTa group, an arthrogram was used to evaluate the HTa angle and reduction (HTa, defined by the intersection of the axis of the humerus shaft and the tangent of the articular surface of the trochlear); In the Baumann group, the Baumann angle was used to assess the reduction. Baumann angle ratio (BA of injured side/BA of contralateral side) was calculated to evaluate the reduction quality between groups. Flynn’s grading criteria were utilized to evaluate both function and cosmetic outcomes in two groups during the follow-up. Operation time, fluoroscopy shots, complications and Flynn’s grading scores were compared between groups.ResultsA total of 57 patients with an average age of 4.62 years and follow-up duration of 21.49 ± 5.40 months were included in the analysis. The gender and age distributions were similar in the two groups. Fluoroscopy shots in the HTa group were significantly less than in Baumann group (16.17 ± 0.73 vs. 21.85 ± 0.78, p < 0.0001), and operation time were also less in HTa group (45.78 ± 1.96 min vs. 62.21 ± 1.58 min, p < 0.0001). Baumann ratio showed no significant difference between the two groups (1.002 ± 0.023 in the Baumann group and 1.01 ± 0.023 in HTa group, p < 0.0001). Length of hospitalization, complications, and Flynn’s grading scores were similar between groups. The HTa angle was positively correlated with Baumann angle in the HTa group (R-value is 0.71 and P = 0.0002).ConclusionsThere was no significant difference in reduction quality and Flynn’s scores between HTa and Baumann groups. Furthermore, HTa was associated with shorter operation time and less radiation exposure in this investigation. Therefore, HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children.

OPEN REDUCTION OF MEDIAL EPICONDYLE FRACTURES IN CHILDREN AND ADOLESCENTS: SUPINE VERSUS PRONE POSITION

Background:Operative treatment of medial epicondyle (ME) fractures can be performed in either supine or prone position. In the supine position, visualization and fixation of the fracture is difficult. However, the prone position requires extensive patient repositioning but may improve visualization.Purpose:The purpose of this study was to compare the results of ORIF of ME fractures between supine and prone positions.Methods:In a retrospective review, patients <18 who underwent open reduction of an acute ME fracture from 2011-2019 were identified. Results and complications were compared between the supine and prone positions.Results:204 patients were included, with a mean age of 11.7 years. 133(65.1%) were sports injuries, and 67(32.8%) had concomitant dislocation, with 17(8.3%) having an incarcerated fracture. 122(60%) patients were in the supine group, and 82(40%) in prone. The mean wheels in-wheels out time was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Mean tourniquet time was 53.1 and 55 minutes in supine and prone positions (P=0.4). C-arm usage was 27.9 and 26.9 seconds in the supine and prone groups, respectively (P=0.7). Displacement of the fracture on the first post-operative x-rays was 2.06 and 1.1 millimeters for the supine and prone groups (P<0.001). A total of 39(19%) patients had some ROM limitation at follow-up, with the majority (33 patients) having <10° loss of ROM. Five patients (2.5%) underwent 7 reoperations due to stiffness, 2 patients due to tardy ulnar nerve palsy, 2 due to non-union, and 53(26%) had a surgical hardware removal. Surgical position was not predictive of complications/reoperation. All of the nine surgeons (out of 16) who have operated at least one patient in the prone position have changed their preferred surgical position to prone.Conclusion:With the largest study population in the literature, the results of our study show that surgical stabilization of medial epicondyle fractures is safe, with minimal complications. While the prone position requires additional time in the operating room, presumably for positioning, the surgical procedure takes the same time and the prone position allows for a more accurate reduction. While the clinical significance of a 1mm difference in reduction quality is unknown, the observation that no surgeon that has tried the prone position had ever gone back to the supine position suggests that the surgical procedure is technically easier in this position.

Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach.

To evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs). Retrospective. Level 1 and level 2 academic centers. Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs. Patients were identified based on Current Procedural Terminology code and chart review. All operative calcaneal fractures treated between 2012 and 2018 by fellowship-trained orthopaedic trauma surgeons were evaluated. Those with both postoperative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): <1 mm step, <5 mm gap, and/or <5° of angulation, fair (F): 1-3 mm step, 5-10 mm gap, and/or 5-15° angulation; and poor (P): >3 mm step, >10 mm gap, and/or >15° angulation. Seventy-seven patients with 83 fractures were included. Average age was 42 years (range, 18-74 years), with 57 men. Four fractures were open. There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA. Average days to surgery were 5 for STA and 14 for ELA (P < 0.001). A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (P < 0.001). There was no difference by approach for Gissane angle (P = 0.5). ELA had better overall reduction quality (P = 0.02). For Sanders II, there was no difference in reduction quality with STA versus ELA (P = 0.51). For Sanders III, ELA trended toward better reduction quality (P = 0.06). The ELA had a better overall reduction of Bohler angle on plain radiographs and of the posterior facet and tuberosity on postoperative CT scans. For Sanders type II DIACFs, there was no difference between STA and ELA. Importantly, for Sanders III DIACFs, ELA trended toward better reduction quality. In addition to fracture reduction, surgeon learning curve, early wound complications, and long-term outcomes must be considered in future studies comparing the ELA and STA. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Les fractures de la paroi postérieure de l’acétabulum associées aux fractures des deux colonnes peuvent être habilement ignorées

IntroductionPosterior wall fractures may be associated with both-column acetabular fractures. Considering the differences in the pattern of these fractures in contrast to isolated posterior wall fractures, it is currently unclear whether they can be ignored or need to be addressed surgically. HypothesisStable posterior wall fractures can be skillfully ignored in patients with both-column acetabular fractures operated by an ilio-inguinal approach. Material and methodsWe retrospectively reviewed 49 consecutive patients who were treated for both-column acetabular fractures between the years 2009 and 2018. Considering the association of posterior wall fractures, we divided the cohort into two groups: group 1 (n=29) absence of posterior wall fractures; and group 2 (n=20) presence of posterior wall fractures, subsequently treated while skillfully ignoring stable posterior wall fracture according to our criteria. Intergroup comparison of radiologic and clinical outcomes and multiple linear regression for predictors of clinical outcomes were analyzed. ResultsNo significant intergroup difference in quality of reduction, post-traumatic osteoarthritis grade, or clinical outcome was noted. Poor post-traumatic osteoarthritis grade and poor quality of reduction of both acetabular columns were significant predictors of clinical outcomes in patients with both-column acetabular fractures. Whether posterior wall fracture was associated and skillfully ignored was unrelated to clinical outcomes. DiscussionPosterior wall fractures associated with both-column acetabular fractures can be successfully ignored if the posterior wall fragment is adequately attached to the acetabulum through the labrocapsular complex of the hip joint, and the hip-joint-congruency in the presence of<2-mm step-off and 3-mm gap. Level of proofIII, prognostic.

Three-dimensional printing of patient-specific plates for the treatment of acetabular fractures involving quadrilateral plate disruption

BackgroundComplicated acetabular fractures comprise the most challenging field for orthopedists. The purpose of this study was to develop three-dimensional printed patient-specific (3DPPS) Ti-6Al-4 V plates to treat complicated acetabular fractures involving quadrilateral plate (QLP) disruption and to evaluate their efficacy.MethodsFifty patients with acetabular fractures involving QLP disruption were selected between January 2016 and June 2017. Patients were divided into a control group (Group A, 35 patients) and an experimental group (Group B, 15 patients), and were treated by the conventional method of shaping reconstruction plates or with 3DPPS Ti-6AL-4 V plates, respectively. The efficacy of Ti-6AL-4 V plates was evaluated by blood loss, operative time, reduction quality, postoperative residual displacement, and complications.ResultsThe operative time and blood loss in Group B were reduced compared to Group A, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction quality between the two groups (P > 0.05). Reduction quality in Group B was anatomic in 10 (66.7%), satisfactory in four (26.7%), and poor in one (6.7%). In Group A, they were anatomic in 18 (51.4%), satisfactory in 13 (37.1%), and poor in four (11.4%). Residual displacement in Group B was less than that in Group A, and the difference was statistically significant (P < 0.05). In Group B, one case exhibited loosening of the pubic screw postoperatively. In Group A, there was one case of wound infection, one of deep vein thrombosis (DVT) in the ipsilateral lower limb, one case of traumatic arthritis and two obturator nerve injuries.ConclusionsThe 3DPPS Ti-6AL-4 V plate is a feasible, accurate and effective implant for acetabular fracture treatment.

Posterior wall fractures associated with both-column acetabular fractures can be skilfully ignored

IntroductionPosterior wall fractures may be associated with both-column acetabular fractures. Considering the differences in the pattern of these fractures in contrast to isolated posterior wall fractures, it is currently unclear whether they can be ignored or need to be addressed surgically. HypothesisStable posterior wall fractures can be skilfully ignored in patients with both-column acetabular fractures operated by an ilioinguinal approach. Material and methodsWe retrospectively reviewed 49 consecutive patients who were treated for both-column acetabular fractures between the years 2009 and 2018. Considering the association of posterior wall fractures, we divided the cohort into two groups: Group 1 (n=29): absence of posterior wall fractures; and Group 2 (n=20): presence of posterior wall fractures, subsequently treated while skilfully ignoring stable posterior wall fracture according to our criteria. Intergroup comparison of radiologic and clinical outcomes and multiple linear regression for predictors of clinical outcomes were analysed. ResultsNo significant intergroup difference in quality of reduction, post-traumatic osteoarthritis grade, or clinical outcome was noted. Poor post-traumatic osteoarthritis grade and poor quality of reduction of both acetabular columns were significant predictors of clinical outcomes in patients with both-column acetabular fractures. Whether posterior wall fracture was associated and skilfully ignored was unrelated to clinical outcomes. DiscussionPosterior wall fractures associated with both-column acetabular fractures can be successfully ignored if the posterior wall fragment is adequately attached to the acetabulum through the labrocapsular complex of the hip joint, and the hip-joint-congruency in the presence of<2-mm step-off and 3-mm gap. Level of proofIII, prognostic.

Effectiveness analysis of three-dimensional printing assisted surgery for unstable pelvic fracture

To evaluate the effectiveness of three-dimensional (3D) printing assisted internal fixation for unstable pelvic fractures. The clinical data of 28 patients with unstable pelvic fractures admitted between March 2015 and December 2017 were retrospectively analyzed. The patients were divided into two groups according to different surgical methods. Eighteen cases in the control group were treated with traditional anterior and posterior open reduction and internal fixation with plate; 10 cases in the observation group were treated with 3D printing technology to make pelvic models and assist in shaping the subcutaneous steel plates of the anterior ring. Sacroiliac screw navigation template was designed and printed to assist posterior ring sacroiliac screw fixation. There was no significant difference between the two groups in gender composition, age, cause of injury, fracture type, and time interval from injury to surgery ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, incision length, waiting time for weight-bearing exercise, and fracture healing time were recorded and compared between the two groups. Majeed score was used to evaluate the function at last follow-up. At immediate after operation, the reduction was evaluated according to Matta imaging scoring criteria, and the success of sacroiliac joint screw implantation in the observation group was evaluated. The deviation of screw entry point and direction between postoperative screws and preoperative simulated screws were compared in the observation group. All the operation was successfully completed, and all patients were followed up 6-18 months (mean, 14.4 months). In the control group, 1 case had wound infection and 2 cases had deep vein thrombosis. No serious complication such as important blood vessels, and nerve injury and pulmonary embolism occurred in other patients in the two groups. No screw pulling out or steel plate breaking occurred. The operation time, intraoperative blood loss, fluoroscopy times, incision length, and waiting time for weight-bearing exercise of the control group were significantly more than those of the observation group ( P<0.05); there was no significant difference in fracture healing time between the two groups ( t=0.12, P=0.90). There was no significant difference in reduction quality between the two groups at immediate after operation ( Z=-1.05, P=0.30); Majeed score of the observation group was significantly better than that of the control group at last follow-up ( Z=-2.42, P=0.02). The success rate of sacroiliac joint screw implantation in the observation group reached category Ⅰ. In the observation group, the deviation angle of the direction of the screw path between the postoperative screw and the preoperative simulated screw implant was (0.09±0.22)°, and the deviation values of the entry points on the X, Y, and Z axes were (0.13±0.63), (0.14±0.58), (0.15±0.53) mm, respectively. There was no significant difference when compared with those before the operation (all values were 0) ( P>0.05). Computer design combined with 3D printing technology to make personalized pelvic model and navigation template applied to unstable pelvic fractures, is helpful to accurately place sacroiliac screw, reduce the operation time, intraoperative blood loss, and the fluoroscopy times, has good waiting time for weight-bearing exercise and function, and it is an optional surgical treatment for unstable fractures.

Postponing surgery of paediatric supracondylar humerus fractures to office hours increases consultant attendance in operations and saves operative room time.

PurposeTo assess if postponing surgery of paediatric supracondylar humerus fractures (SCHF) without compromised blood circulation to office hours can improve the quality of reduction and pin fixation and decrease complications.MethodsIn 2004, night-time (0am to 7am) surgery was allowed only for children with compromised blood circulation. Number of open reductions, surgeons experience, operation time, quality of reduction (Baumann angle, anterior humeral line crossing point with capitellum) and pin fixation as well as the number of complications were compared in 100 children before (A) and 100 after (B) the new protocol. Surgery was commenced during office hours (8am to 3pm) in 27% (A) versus 55% (B) and delay to surgery from admission exceeded six hours in 25% (A) versus 52% (B) of the children.ResultsOpen reduction was performed in eight (A) versus 11 (B) children. In group A, 40% were operated on by a registrar alone compared with 14% in group B. Mean operation room time decreased by 11 minutes in group B. Radiographic alignment was satisfactory at fracture union in 68% (A) versus 68% (B) and radiologically stable pin fixation in 42% (A) versus 55% (B) of children (p = 0.08). The was no statistical difference in admission time, re-reductions, infections, permanent iatrogenic nerve injuries or corrective osteotomies between the patient groups.ConclusionsNo statistical difference in quality of reduction or pin fixation or in number of complications was observed. Postponing operative treatment of SCHF without vascular compromise increased consultant attendance in operations and decreased operative room time.Level of EvidenceIII - retrospective comparative study

The lateral radiograph is useful in predicting shortening in 31A2 pertrochanteric hip fractures.

We sought to determine if angulation or translation measured on the lateral preoperative injury radiographs of patients with 31A2 pertrochanteric fractures is related to excessive postoperative shortening when treated with a sliding hip screw. We retrospectively reviewed the radiographs of consecutive patients with hip fractures treated at a level I university trauma centre between 2003 and 2008. Patients with 31A2 pertrochanteric fractures treated with a sliding hip screw were identified through a search of medical records. The study variables were angulation and translation on the preoperative injury lateral radiograph. The outcome measure was radiographic evidence of fracture shortening, measured as the change in length of sliding hip screw visible outside the barrel between the time of fixation and final follow up. Of the 131 patients treated, 23 met our inclusion criteria and had sufficient follow-up (mean 6.4 mo). The average shortening for 31A2 fractures with angulation on the injury lateral radiograph was 1.83 (95% confidence interval [CI] 1.18-2.47) cm, compared with 0.93 (95% CI 0.49-1.36) cm for fractures with no angulation (p = 0.019). There was no statistical difference in quality of reduction, tip-apex distance, Orthopedic Trauma Association (AO/OTA) classification or incidence of lateral wall fracture across groups based on the presence of angulation. Angulation on the lateral preoperative injury radiograph may be useful in predicting excessive shortening in 31A2 pertrochanteric fractures. Further investigation is warranted to confirm this result and to identify the role of other predictors, such as fracture comminution.