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. 2025 Apr 18;16(4):106862.
doi: 10.5312/wjo.v16.i4.106862.

Medial cortical reduction does not influence outcomes in geriatric intertrochanteric femur fractures treated with proximal femoral nail

Prabu Mounisamy  1 , Hanoop Suresh  1 , Sushma Chandrashekar  1 , Udayakumar D  2 , Naveen Jeyaraman  3   4 , Madhan Jeyaraman  3   5 , Sathish Muthu  4   6
Affiliations

Medial cortical reduction does not influence outcomes in geriatric intertrochanteric femur fractures treated with proximal femoral nail

Prabu Mounisamy et al. World J Orthop. .

Abstract

Background: In intertrochanteric fractures, the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.

Aim: To analyze the concept of medial cortical reduction (MCR) and its clinical and radiological association in geriatric intertrochanteric femur fractures.

Methods: Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study. Based on the degree of MCR, they were divided into positive, neutral, or negative MCR groups. The demographic baseline characteristics, postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6, 12 and 24 weeks post-surgery. Functional outcomes such as modified Harris Hip Score (HHS) and time to full-weight bearing were also analyzed.

Results: 47 patients (Male: Famale 35:12) with mean age of 65.8 ± 4.2 years were included in this study. Twenty-two cases had neutral support, nine had negative support, and sixteen had positive support in the medial cortex post-operatively. Baseline characteristics of the three groups were comparable. No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups. The modified HHS was not found to be significant between the groups (P = 0.883) as that of the time to full weight bearing (P = 0.789).

Conclusion: The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse. Future randomized controlled trials are needed to validate the findings noted in the study.

Keywords: Cephalomedullary nail; Intertrochanteric femur fracture; Medial cortex; Proximal femoral nail; Varus collapse.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

Figures

Figure 1
Figure 1
Three types of reduction with respect to the medial cortex alignment.
Figure 2
Figure 2
Illustrative case of unstable intertrochanteric femur fracture with positive medial cortical alignment.
See this image and copyright information in PMC

References

    1. Harris E, Clement N, MacLullich A, Farrow L. The impact of an ageing population on future increases in hip fracture burden. Bone Joint J. 2024;106-B:62–68. - PubMed
    1. Makaram NS, Hall AJ, Clement ND, MacLullich AJ, Simpson AHRW. Lessons learned from hip fracture registries - From the Scottish perspective to global practice. Injury. 2023;54 Suppl 5:110935. - PubMed
    1. Dong Y, Zhang Y, Song K, Kang H, Ye D, Li F. What was the Epidemiology and Global Burden of Disease of Hip Fractures From 1990 to 2019? Results From and Additional Analysis of the Global Burden of Disease Study 2019. Clin Orthop Relat Res. 2023;481:1209–1220. - PMC - PubMed
    1. Hadjimichael AC. Hip fractures in the elderly without osteoporosis. J Frailty Sarcopenia Falls. 2018;3:8–12. - PMC - PubMed
    1. George J, Sharma V, Farooque K, Mittal S, Trikha V, Malhotra R. Injury Mechanisms of Hip Fractures in India. Hip Pelvis. 2021;33:62–70. - PMC - PubMed

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