The Relationship Between The Integrity Of The Lateral Femoral Wall And The Outcome Of Intertrochanteric Fractures Fixed With PFNA

Objective: To investigate the relationship between the integrity of thelateral femoral wall and the outcome of intertrochanteric fractures fixed withPFNA.Methods: From January2010to January2013, A retrospective studywith92patients underwent intertrochanteric fractures treated with PFNAwas carried out. According to the plain radiographs taken on the firstpostoperative day, the patients were divided into two groups. The group withlateral wall fracture included43cases, and the other49cases were in thegroup without lateral wall fracture. In accordance with the preoperative plainradiographs and CT images, the cases of lateral wall fracture were furtherdivided into preoperative fracture subgroup(34cases) and intra-operativefracture subgroup(9cases). Furthermore, the cases with comminuted medialcortex were divided into two groups. The group with lateral wall fractureincluded20cases, and the other22cases were in the group without lateralwall fracture. The terms of sex, age, TAD, fracture reduction, neck-shaft angle discrepancy and Harris hip score in each group were recorded andcompared.Results: There were no significant differences between all comparativegroups in terms of sex, age, TAD, fracture reduction(P>0.05). Theneck-shaft angle discrepancy and Harris hip score in the group with lateralwall fracture were2.34°,84versus1.95°,85in the group without lateral wallfracture respectively, but the two terms in the two groups were notsignificantly different. There were no significant differences in terms ofneck-shaft angle discrepancy and Harris hip score between preoperativefracture subgroup and intra-operative fracture subgroup (P>0.05). Duringwith comminuted medial cortex, the neck-shaft angle discrepancy in thegroup with lateral wall fracture(3.79°) was bigger than that in the groupwithout lateral wall fracture(2.71°), in addition that in the two groups wassignificantly different (P<0.05). Similarly the Harris hip score in the groupwith lateral wall fracture and the group without lateral wall fracture wassignificantly different (82versus84,P<0.05).Conclusion: The presence of lateral wall fracture did not increase therisk of failure and decrease hip function of intertrochanteric fractures fixedwith PFNA. In addition there were no differences between preoperative andintra-operative lateral wall fracture. Along with comminuted medial cortex,the presence of lateral wall fracture possibly increase the risk of failure anddecrease hip function.