title: Radiologic healing of lateral femoral wall fragments after intramedullary nail fixation for A3.3 intertrochanteric fractures.
abstract: BACKGROUND
  Intramedullary nail fixation is a useful treatment option for A3 intertrochanteric fractures. Occasionally, we have encountered displaced lateral femoral wall (LFW) fragment during surgery with intramedullary nail system. We investigated the postoperative spontaneous reduction of displaced LFW fragments without further fixation and the factors that affected the spontaneous reduction of displaced LFW fragments.
  
  
  METHODS
  Forty-four patients with A3.3 intertrochanteric fracture were treated by surgery using intramedullary nails (PFNA; Synthes, Paoli) between March 2007 and December 2012. All patients had a minimum follow-up period of 12 months. We calculated the amount of spontaneous reduction of the displaced LFW fragments from immediate postoperative and last follow-up anteroposterior radiographs. We measured the tilting angle of the LFW fragment, tip-apex distance (TAD), and telescoping of the blade, and evaluated the quality of postoperative reduction.
  
  
  RESULTS
  Twenty-five of the 44 patients had displaced LFW fragments, and the average amount of spontaneous reduction of the displaced LFW fragment was 4.8 mm with statistical significance (p = 0.005). The average tilting angle of all patients was -4.97°, telescoping was 6.83 mm, and TAD was 19.77 mm. Twenty-one patients had good quality of reduction, 21 had acceptable quality, and 2 had poor quality. Multivariate logistic regression analysis for these factors indicated that tilting angle was the only significant factor related to spontaneous reduction of a displaced LFW fragment (p = 0.007, odds ratio = 1.336).
  
  
  CONCLUSIONS
  In intramedullary nailing of A3.3 intertrochanteric fractures, the displaced LFW fragments tend to reduce spontaneously without any additional fixation during the postoperative period. We conclude that no additional fixation is needed for the displaced LFW fragment after surgery with intramedullary nail.
authors.affiliation: Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
authors.forename: Youngwoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.
authors.forename: Won Jong
authors.initials: WJ
authors.lastname: Bahk
authors.affiliation: Department of Trauma Center, Gacheon University Gil Hospital, Incheon, Republic of Korea.
authors.forename: Yong-Cheol
authors.initials: YC
authors.lastname: Yoon
authors.affiliation: Department of Orthopaedic Surgery, Korea University Guro Hospital , Seoul, Republic of Korea.
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Cho
authors.affiliation: Department of Orthopaedic Surgery, Korea University Guro Hospital , Seoul, Republic of Korea.
authors.forename: Won-Yong
authors.initials: WY
authors.lastname: Shon
authors.affiliation: Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Chang-Wug
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Korea University Guro Hospital , Seoul, Republic of Korea. jkoh@korea.ac.kr.
authors.forename: Jong-Keon
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006620:Hip Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011859:Radiography
keywords: AO-OTA classification; Intertrochanteric fracture; Lateral femoral wall; Proximal femoral nailing