title: Does integrity of the lesser trochanter influence the surgical outcome of intertrochanteric fracture in elderly patients?
abstract: BACKGROUND
  Most surgeons do not fix the lesser trochanter when managing femoral intertrochanteric fractures with intramedullary nails. We have not found any published clinical studies on the relationship between the integrity of the lesser trochanter and surgical outcomes of intertrochanteric fractures treated with intramedullary nails. The purpose of this study was to evaluate the impact of the integrity of the lesser trochanter on the surgical outcome of intertrochanteric fractures.
  
  
  METHODS
  A retrospective review of 85 patients aged more than 60 years with femoral intertrochanteric fractures from January 2010 to July 2012 was performed. The patients were allocated to two groups: those with (n = 37) and without (n = 48) preoperative integrity of the lesser trochanter. Relevant patient variables and medical comorbidities were collected. Medical comorbidities were evaluated according to the American Society of Anesthesiologists classification and medical records were also reviewed for age, sex, time from injury to operation, intraoperative blood loss, volume of transfusion, operative time, length of stay, time to fracture union, Harris Hip Score 1 year postoperatively, and incidence of postoperative complications. Postoperative complications included deep infection (beneath the fascia lata), congestive heart failure, pulmonary embolus, cerebrovascular accident, pneumonia, cardiac arrhythmia, urinary tract infection, wound hematoma, pressure sores, delirium, and deep venous thrombosis. Variables were statistically compared between the two groups, with statistical significance at P<0.05.
  
  
  RESULTS
  Patients with and without preoperative integrity of the lesser trochanter were comparable for all assessed clinical variables except fracture type (P < 0.05). There were no statistically significant differences between these groups in time from injury to operation, volume of transfusion, length of stay, time to fracture union, Harris Hip Score at 1 year postoperatively, and incidence of postoperative complication (P > 0.05). The group with preoperative integrity of the lesser trochanter had significantly less blood loss (107.03 ± 49.21 mL) than those without it (133.96 ± 58.08 mL) (P < 0.05) and the operative time was significantly shorter in the former (0.77 ± 0.07 hours) than the latter (0.84 ± 0.11 hours) group (P < 0.05).
  
  
  CONCLUSIONS
  The integrity of the lesser trochanter has no significant influence on the surgical outcome of intramedullary nail internal fixation of femoral intertrochanteric fractures.
authors: First Hospital of Shijiazhuang, Shijiazhuang, 050000, China. sjzxh@yeah.net.|Department of Orthopedic Center, First Hospital of Shijiazhuang, 36 Fan Xi Road, Shijiazhuang, Hebei, 050000, China. sjzxh@yeah.net.
authors: Xiaohui
authors: X
authors: Liu
authors: Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China. liuyueju1983@gmail.com.
authors: Yueju
authors: Y
authors: Liu
authors: First Hospital of Shijiazhuang, Shijiazhuang, 050000, China. panshuodoctor@126.com.
authors: Shuo
authors: S
authors: Pan
authors: First Hospital of Shijiazhuang, Shijiazhuang, 050000, China. caohuijiandoctor@126.com.
authors: Huijian
authors: H
authors: Cao
authors: First Hospital of Shijiazhuang, Shijiazhuang, 050000, China. yudahaidoctor@126.com.
authors: Dahai
authors: D
authors: Yu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation; D017102:Fracture Healing; D006620:Hip Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome