Surgical strategies for unstable fractures of intertrochanteric lateral wall

Objective To investigate the surgical strategies for management of unstable fractures of intertrochanteric lateral wall. Methods From July 2012 to June 2014, 50 patients with unstable fractures of intertrochanteric lateral wall received osteosynthesis with proximal femoral nail anti-rotation. They were 37 men and 13 women, with an average age of 65. 6 years(range, from 42 to 87 years). According to our morphology classification, 25 patients belonged to type I(comminuted fracture of lateral wall), 4 to type II(split fracture of lateral wall with loss of medial support), 21 to type Ⅲ(comminuted fracture of lateral wall and subtrochanteric part with loss of medial support). The fractures were managed differently according to our classification. Type I were treated by intramedullary fixation with compression screws to reconstruct the lateral wall, type II by intramedullary fixation after reconstruction of the lateral wall by cables, and type Ⅲ by intramedullary fixation after optimal reduction of the coronal plane and neck-shaft angle because the lateral wall could not be reconstructed. Results The 50 patients obtained an average follow-up of 17 months(range, from 5 to 24 months). No deep infection or wound dehiscence happened. Deep vein thrombosis occurred in 2 patients. No nonunion, cutout of the sliding screw, or coxa vara occurred. The operation time, blood loss, time of weight loading after operation and time of union increased with our increased classification. One patient died from a heart disease 5 months after operation. Functional outcome of the other 49 patient was assessed by Harris hip score one year after operation. Forty patients were excellent, 6 good and 3 fair, giving an excellent to good rate of 93. 9% Conclusion Unstable fractures of intertrochanteric lateral wall should be treated using different surgical strategies based on the morphology classification system. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Functional outcomes; Lateral wall