title: Provisional pin fixation: An efficient alternative to manual maintenance of reduction in nailing of intertrochanteric fractures.
abstract: BACKGROUND
  During nailing of intertrochanteric fractures, there is always a risk of reduction loss despite achieving an acceptable reduction status after a percutaneous procedure. Most surgeons usually attempted to maintain the reduction with a manual endeavor. However, we experienced varying amounts of intraoperative reduction loss and had to perform readjustments several times. These struggles motivated us to attempt provisional pin fixation as an alternative method. The purpose of this study was to analyze the factors affecting intraoperative reduction loss, especially in comparison between two methods.
  
  
  METHODS
  Sixty-eight patients with intertrochanteric fractures were included. They were divided into two groups based on the method, by retrospective analysis of the intraoperative c-arm image. In the manual maintenance group, an assistant maintained the instruments during the procedure. In the provisional pin fixation group, the reduction was temporaryily held by a 3.2mm guide pin fixation across the fracture. A displacement of more than one cortical thickness in any plane or angular deformity during any point in the procedure after acceptable reduction was judged as an intraoperative reduction loss. Multivariate logistic regression was used for statistical analysis.
  
  
  RESULTS
  The number of cases with intraoperative reduction loss was 18 (18 of 38, 46.1%) in the manual maintenance group and 6 (6 of 30, 20.0%) in the provisional pin fixation group. The odds ratio of intraoperative reduction loss in the manual maintenance group was 5.182 (95% confidence interval, 1.455-18.452) compared with the provisional pin fixation group as the reference.
  
  
  CONCLUSIONS
  As a reasonable approach for maintaining reduction, provisional pin fixation can significantly decrease intraoperative reduction loss after percutaneous reduction of intertrochanteric fractures during nailing.
authors.affiliation: Department of Orthopaedic Surgery, Korea University Guro Hospital, 80, Guro-Dong, Guro-Gu, Seoul, 152-703, Republic of Korea. ccarius85@gmail.com.
authors.forename: Won-Tae
authors.initials: WT
authors.lastname: Cho
authors.affiliation: Department of Orthopaedic Surgery, Korea University Guro Hospital, 80, Guro-Dong, Guro-Gu, Seoul, 152-703, Republic of Korea. jeus1103@gmail.com.
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Cho
authors.affiliation: Trauma Center, Gachon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760, Republic of Korea. dryoonyc@gmail.com.
authors.forename: Yong-Cheol
authors.initials: YC
authors.lastname: Yoon
authors.affiliation: Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-Ro, Uijeongbu-si, Gyeonggi-do, 480-717, Republic of Korea. medic-young@hanmail.net.
authors.forename: Youngwoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 700-721, Republic of Korea. cwoh@knu.ac.kr.
authors.forename: Chang-Wug
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Department of Orthopaedic Surgery, Korea University Guro Hospital, 80, Guro-Dong, Guro-Gu, Seoul, 152-703, Republic of Korea. jongkeon.oh@gmail.com.
authors.forename: Jong-Keon
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Intertrochanteric fracture; Percutaneous reduction; Pertrochanteric fracture; Provisional pin fixation; Reduction method