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. 2022 Oct 13;14(6):38560.
doi: 10.52965/001c.38560. eCollection 2022.

Cephalomedullary nailing for reverse oblique intertrochanteric fractures 31A3 (AO/OTA)

Emanuela Marsillo  1 , Andrea Pintore  1 , Giovanni Asparago  1 , Francesco Oliva  1 , Nicola Maffulli  2
Affiliations

Cephalomedullary nailing for reverse oblique intertrochanteric fractures 31A3 (AO/OTA)

Emanuela Marsillo et al. Orthop Rev (Pavia). .

Abstract

Introduction: Reverse oblique intertrochanteric fractures are classified by the Orthopaedic Trauma Association [OTA]/[AO] as 31A3, and account for up to one-third of all hip fractures, and 2-23% of all trochanteric fractures. The treatment of choice of those fractures is intramedullary nailing as it decreases soft tissue damage and permits early weight bearing.

Material and methods: A retrospective comparative study was conducted on patients surgically treated for 31A3 fractures from October 2018 to January 2022 in a high-volume regional referral centre. All the patients had been treated with intramedullary nailing.

Results: The selected group included 11 males (16%) and 59 females (84%), with a mean age of 83.6 years (range 61 to 96 years). A Trigen Intertan Nail was the most frequent choice of intramedullary nailing in 33 patients (47%), an Elos Long nail was chosen in 19 cases (27%), while a ZNN nail was used in 18 patients (26%). The mean time between admission and surgery was 2.5 days, with a mean Hb value of 10.5 g/dl reported preoperatively.

Conclusion: Patients treated with an Intertan nail reported the lowest TAD, CALTAD, and TALCALTAD mean radiographic values, and the lowest rate of Hb loss and blood transfusions.

Keywords: 31A3.; femur; fractures; nail; reverse oblique intertrochanteric; surgery.

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Conflict of interest statement

The authors declare that they have no conflict of interest

Figures

Figure 1.
Figure 1.. Intertrochanteric (reverse obliquity) fracture 31A3 by Modified AO/OTA classification 2018
Figure 2.
Figure 2.. In the AP view, using a line through the femoral head, the distance between the apex of the femoral head and the tip of the cephalic screw represents the TAD (TADAP).
Using a line tangent to the medial cortex of the femoral neck, the CalTAD (CalTADAP) is measured
Figure 3.
Figure 3.. AP view of a 31A3.1 fracture underwent intramedullary nailing with Zimmer Natural Nail System (ZNN CephaloMedullary Femoral Nail Zimmer; Warsaw; IN, USA).
A: Pre-operative radiography. B: Post-operative radiography.
Figure 4.
Figure 4.. AP view of a 31A3.3 fracture underwent intramedullary nailing with long nail ELOS (InTrauma, Rivoli, Italy).
A: Pre-operative radiography. B: Post-operative radiography.
Table 1.
Table 1.. Demographics data, comorbidities, intra- and post-operative parameters.
See this image and copyright information in PMC

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