Evaluation of Medial Cortical Reduction Pattern on Clinico-Radiological Outcome after Fixation of Intertrochanteric Fractures

Abstract

Background: Unstable intertrochanteric fractures in elderly patients are associated with high morbidity and mechanical complications. Medial cortical reduction pattern has been suggested as an important determinant of postoperative stability and functional recovery. This study aimed to evaluate the effect of medial cortical reduction patterns on clinico-radiological outcomes following proximal femur nail antirotation (PFNA2) fixation.

  Methods: A prospective observational study was conducted in the department of orthopaedics at Integral institute of medical sciences and research (IIMS&R), Lucknow, over 18 months after approval from institutional ethics committee (IEC/IIMSR/2024/36). Sixty-two patients aged ≥60 years with unstable intertrochanteric fractures (AO31A2) treated with PFNA2 were included in the study. There were 33 males and 29 females, with a mean age of 71.9 ± 6.43 years (range 62–85 years).  Based on the medial cortical reduction pattern on immediate postoperative radiographs, patients were categorised into 3 groups: positive (n=22), neutral (n=24) and negative (n=16). Radiological outcomes (fracture union, varus collapse, implant-related complications) and functional outcome using Modified Harris Hip Score (mHHS) were assessed at 6 months. Statistical analysis was performed using SPSS version 26.0, with p<0.05 considered as significant.

  Results: Fracture union rates were highest in the positive reduction group (95.5%) compared to neutral (87.5%) and negative groups (62.5%) (p=0.098). Varus collapse was significantly more frequent in the negative group (37.5%) than in the positive (4.5%) and neutral groups (12.5%) (p=0.020). Mean mHHS was significantly higher in the positive group (87.7±3.7) compared to neutral (78.6±3.6) and negative groups (68.3±3.3) (p<0.001). Excellent functional outcomes were predominantly observed in the positive reduction group.

  Conclusion: Positive medial cortical reduction is associated with superior radiological stability and functional recovery following PFNA2 fixation of unstable intertrochanteric fractures in elderly patients. Achieving positive medial cortical support should be emphasised to optimise surgical outcomes.