Evaluate the Outcome of Trochanteric Fracture Fixation Concerning Proximal Femoral Lateral Wall Thickness in Suez Canal University Hospitals

Abstract

Background: Lateral wall competency of Intertrochanteric fractures has been considered as a mitigating factor to instability, and its incompetency will be associated with high rate of complications.

Aim: Improvement of the outcome of Intertrochanteric fracture management.

Patients and methods: This cohort prospective study was conducted on 65 patients which had stable intertrochanteric fracture: Evans stable Type 1(two-part fractures AO type

31-A1.1 to 31-A2.1) with preoperative intact lateral wall and thickness less than 20.5mm in all cases that underwent fixation in Suez Canal university hospitals during the period between March 2020 to March 2022. Evaluating the Role of preoperative assessment of Lateral Wall thickness and its value in choosing fixation method and assessing the relation between Lateral Wall thickness and fixation failure.

Results: There were 19 cases (54.3%) fixed by DHS reported post operative lateral wall fracture while only 5 cases fixed by PFN reported post operative lateral wall fracture with highly significant P value <0.002.Comparing post operative Harris Hip Score (HHS) regarding methods of fixation showed highly significant difference with P value <0.001 as the mean HHS of cases fixed by PFN 78.37 while 69.17 in DHS cases.The mean pre-injury (HHS) was 91.66± 1.5 with range from 90 to 96 while the mean post-injury (HHS) was 73.42± 8.98 with range from 50 to 86 (p<0.001). Complications reported as 12 cases (18.5%) with varus malunion, 2 patients (3.1%) experienced implant failure due to cut through, 13 cases (20%) reported shortening. Two patients (3.1%) had current need for reoperation. None of the patients reported wound infection.

Conclusion: Lateral wall thickness is an accurate predictor of post-operative lateral wall fracture and its integrity should be a major objective during fixation. Determination of pre-operative thickness will help to choose method of fixation thus decrease post-operative complication and improving patient functional outcome. Lateral wall of 20.5 mm is considered a threshold value for the use of DHS and this can be expected to minimize the risk of post-operative lateral wall fracture.