Hip Pelvis.  2013 Dec;25(4):280-285. 10.5371/hp.2013.25.4.280.

The Antero-medial Cortex Overlapped Reduction of Unstable Intertrochanteric Fractures

• Kim CG
• Kweon SH
• Han HJ
• Hwang JS

• KMID: 1808136
• DOI: http://doi.org/10.5371/hp.2013.25.4.280

Abstract

PURPOSE
The purpose of this article is to evaluate the result of treatment of unstable intertrochanteric fractures by lateralization of distal fragment and antero-medial cortex contact of the distal shaft piece.
MATERIALS AND METHODS
We conducted an analysis of 20 cases of unstable intertrochanteric fractures treated using a gamma-3 nail from August 2011 to August 2012 and followed up for more than one year. Using postoperative and last follow-up radiographs, we measured NSA, TAD, Cleveland index, sliding length of the lag screw, and union time. Adequacy of reduction was assessed by a modification in the criteria of Baumgaertner and classified as good, acceptable, or poor.
RESULTS
The mean NSA was 140degrees postoperative and 135degrees at last follow-up. The mean TAD was 11.3 mm. The position of the lag screw was in center-center in 12 cases, center-inferior in eight cases. The mean distance of lag screw sliding was 5.5 mm at last follow-up. The mean union time was 3.7 months. The state of reduction postoperatively was good in 15 cases, and acceptable in five cases. There was no failure of reduction, lag screw cut-out, or other complications at last follow-up.
CONCLUSION
The reduction method for lateralization of distal fragment and antero-medial cortex contact of the distal shaft piece in an unstable intertrochanteric fracture is very useful for prevention of collapse of the fracture site, lag screw cut-out, and mechanical failure.

Keyword

Unstable intertrochanteric fracture; Overlap reduction; Gamma-3 nail

MeSH Terms

Follow-Up Studies
Hip Fractures*
Methods

Figure

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  Fig. 1 Jensen classification. Type 3- loss of posterolateral support, Type 4- loss of medial support, Type 5- four part.

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  Fig. 2 (A) Pre-operative radiograph shows lateral displacement of proximal fragment. (B) Radiographs show medialization of proximal fragment using by Steinmann pin and antero-medial cortex overlapping. (C) Radiograph shows that Steinman pin is keeping to maintain the reduction during nail insertion.

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  Fig. 3 (A) Preoperative radiographs show 4-part intertrochanteric fracture. (B) Postoperative radiographs show valgus reduction in AP view and anterior angulation in lateral view. (C) Follow-up radiographs after 3 months show bone union.

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