Clin Orthop Surg.  2018 Sep;10(3):292-298. 10.4055/cios.2018.10.3.292.

The Effect of Positive Medial Cortical Support in Reduction of Pertrochanteric Fractures with Posteromedial Wall Defect Using a Dynamic Hip Screw

• Cho MR
• Lee JH
• Kwon JB
• Do JS
• Chae SB
• Choi WK

• KMID: 2418748
• DOI: http://doi.org/10.4055/cios.2018.10.3.292

Abstract

BACKGROUND
We evaluated the radiological and clinical results of reduction using a dynamic hip screw according to the grade of medial cortical support in patients with AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification type 31-A2 pertrochanteric fractures.
METHODS
We enrolled 100 patients with AO/OTA type 31-A2 fractures with displaced lesser trochanter fragments (length of the cortical area longer than 20 mm on the pelvis anteroposterior view). Patients with positive medial cortical support were assigned to group 1 (n = 28); neutral medial cortical support, group 2 (n = 42); and negative medial cortical support, group 3 (n = 30). Radiological evaluation was done by measuring the change in the femoral neck-shaft angle and sliding distance of the lag screw. Clinical outcomes of each group were compared by means of the walking ability score proposed by Ceder.
RESULTS
Group 1 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than groups 2 and 3. Group 2 showed significantly less changes in the femoral neck-shaft angle and shorter sliding distance than group 3. Group 1 showed significantly higher walking ability scores than group 3 (p = 0.00). The use of trochanter stabilizing plates or fixation using wires for posteromedial wall defect resulted in no significant changes in terms of the femoral neck-shaft angle or sliding distance.
CONCLUSIONS
In the treatment of pertrochanteric fractures accompanied by posteromedial wall defect using a dynamic hip screw, reduction with negative cortical support should be avoided.

Keyword

AO/OTA 31-A2; Dynamic hip screw; Medial cortical support

MeSH Terms

Classification
Femur
Hip*
Humans
Pelvis
Walking

Figure

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  Fig. 1 Flowchart of patient selection. AO/OTA: AO Foundation and Orthopaedic Trauma Association classification, DHS: dynamic hip screw, LT: lesser trochanter.

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  Fig. 2 (A) Reduction with positive medial cortical support. (B) Reduction with neutral medial cortical support. (C) Reduction with negative medial cortical support.

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  Fig. 3 The length of the posteromedial cortex (arrow), including the displaced lesser trochanter, measured on the preoperative pelvis anteroposterior view was ≥ 20 mm for inclusion in the study.

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