A Review of Fixation Modalities for Thin Lateral Cortex - Intertrochanteric Femoral Fractures

Recently, there is an increasing awareness of the importance of the integrity of the lateral wall of the proximal femur, besides the previous agreement on the integrity of the posteromedial portion of the proximal femur, which was considered the most important prognostic indicator of fracture stability. Therefore, this study aimed to compare outcomes of fixation modalities used to treat thin lateral wall intertrochanteric proximal femur fracture. Methods: In this retrospective study, seventy-five treated thin lateral cortex intertrochanteric fractures were evaluated radiologically at different follow-up intervals to measure the outcome of different treatments. Dynamic Hip screw (DHS), Dynamic Condylar Screw (DCS), and Proximal Femoral Nail (PFN) were compared regarding healing, mortality, and complications. Results: The mean age of patients was 76.75±11.37 years, and 61.3% of them had comorbidities. The three used treatments were similar regarding healing time, need for revision, and mortality rate. The one-year mortality rate was 12%. PFN maintained a superior accepted position on follow-up. Although DHS showed an excellent reduction on initial postoperative X-ray, less than half of fractures sustained accepted reduction on the first follow-up secondary to medialization of the shaft (32%) and varus collapse (24%). Additionally, DHS was most commonly associated with nonunion. Intraoperative lateral wall fracture in DHS treatment occurred in 15.4%. DCS was the inferior treatment and the most commonly associated with varus collapse. Conclusions: In the fixation of thin lateral wall entity intertrochanteric fracture, PFN revealed superior results regarding reduction and lower complication rate than other modalities. Therefore, PFN should be used, and DHS and DCS should be avoided in this fracture pattern