Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures.

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Abstract

[Indexed for MEDLINE] 3. J Orthop Trauma. 2014 Aug;28 Suppl 8:S25-8. doi: 10.1097/BOT.0000000000000187. Unstable pertrochanteric femoral fractures. Kregor PJ(1), Obremskey WT, Kreder HJ, Swiontkowski MF. Author information: (1)*Division of Orthopaedic Trauma, Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, TN; †Department of Orthopaedic Surgery, Sunnybrook Health Science Centre, Toronto, Ontario, Canada; and ‡Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, on behalf of the Evidence-Based Orthopaedic Trauma Working Group. BACKGROUND: Fractures in the trochanteric region of the femur are classified as AO/OTA 31-A, as they are extracapsular (). This report analyzes the relatively rare 31-A3 fracture, which has also been referred to as an "intertrochanteric femur fracture with subtrochanteric extension," "reverse obliquity intertrochanteric femur fracture," "unstable intertrochanteric femur fracture," or a "subtrochanteric femur fracture." The A3 fracture is characterized by having a fracture line exiting the lateral femoral cortex distal to the vastus ridge. Possible fixation constructs include compression hip screws, intramedullary hip screws, trochanteric intramedullary nails, cephalomedullary antegrade intramedullary nails, and 95° plates. Most reports investigating 31-A fractures do not describe the 31-A3 fracture. For this analysis, only reports clearly indicating that the fracture treated was a 31-A3 were included. It should be understood that this approach therefore excludes reports on generic "subtrochanteric fractures" or "intertrochanteric fractures," some of which may have been 31-A3 fractures. OBJECTIVE: To determine the effect of fixation technique for the AO/OTA 31-A3 fracture on rates of union, infection, risk of reoperation, and functional outcomes. DOI: 10.1097/BOT.0000000000000187