THE IMPORTANCE OF THE INTEGRITY AND THICKNESS OF THE LATERAL WALL IN THE MANAGEMENT OF INTERTROCHANTERIC FEMORAL FRACTURES.

THE IMPORTANCE OF THE INTEGRITY AND THICKNESS OF THE LATERAL WALL IN THE MANAGEMENT OF INTERTROCHANTERIC FEMORAL FRACTURES.

Authors
Panagiotis Mantzanas1,  Michail Michalos2, Stefania Kanata3, Stamatios Tsamados4
1North West University Healthcare NHS Trust, London UK, 2Imperial College Healthcare NHS Trust, London UK, 3University College London Hospitals NHS Foundation Trust, London UK, 4King’s College Hospital NHS Foundation Trust, London UK

Introduction
Intertrochanteric femoral fractures are common injuries and they account for approximately 50% of hip fractures. They are associated with a high burden of morbidity and mortality globally. The optimal and prompt surgical management is crucial for functional rehabilitation of these patients and reduced morbidity and mortality.

Aim
This study aims to reiterate the importance of the routine assessment of the lateral wall thickness of all intertrochanteric femoral fractures and determine which fixation device is more appropriate for use (dynamic/sliding hip screw versus intramedullary nail)

Material & Methods
According to AO/OTA classification, multifragmentary peritrochanteric fractures with incompetent wall are classified as 31A1 or 31A2, depending on the lateral wall thickness of the greater trochanter.
Lateral wall thickness is defined as the distance in millimeters (mm) from a reference point 3 cm below the innominate tubercle of the greater trochanter angled 135° upward to the fracture line on the anteroposterior (AP) plain radiograph. The thickness must be less than 20.5mm for the fracture to be considered as 31A2.

Results
31A2 peritrochanteric fractures treated with dynamic/sliding hip screw fixation have a higher risk of developing a secondary (post-operative) lateral wall fracture and subsequent risk of failure of fixation.

Conclusions
Lateral wall thickness should be measured/assessed in all intertrochanteric femoral fractures.
Dynamic/sliding hip screw fixation alone should be avoided in the cases where lateral wall thickness is less than 20.5mm or in cases where there is already a lateral wall fracture.