Potentially unstable intertrochanteric fractures

Objectives: Evaluation of risk factors for loss of reduction in initially stable intertrochanteric fractures. Design: Retrospective database analysis. Setting: University teaching hospital. Patients/Participants: Sixty-six patients over the age of 55 years presenting with fractures of the trochanteric region caused by a low-energy injury, classified as AO/OTA type 31-A1 (stable fracture in Evans classification). Intervention: Treatment with a sliding compression hip screw. Main Outcome Measurement: The outcome examined in this study was loss of reduction as measured by the amount of medialization of the femoral shaft. Results: Increased age (P = 0.01) and comminution of the lateral cortex (P = 0.0001) were factors significantly associated with excessive displacement. These 2 factors had a high degree of correlation (r = 0.76). Conclusions: A surgeon must be aware of iatrogenic fragmentation of the lateral cortex at the time of surgery in apparently stable intertrochanteric fractures in older patients because of the potential for subsequent loss of reduction.