Predictive variables of open reduction in intertrochanteric fracture nailing: a report of 210 cases.
BACKGROUND
Factors that impede closed reduction in intertrochanteric fractures remain unknown. This study was designed with the aim of establishing radiological variables that can predict an open reduction when nailing those type of fractures.


METHODS
Observational prospective study carried out between March 2013 and March 2015. Patients of both gender who suffered an intertrochanteric fracture, and who were surgically treated by intramedullary nailing (PFN-A), were included. Patients were evaluated by means of a questionnaire designed in 12 de Octubre Trauma department. Radiological parameters assessed preoperatively, after fracture reduction in the traction table, and after fixation were: calcar, lateral wall and posterior buttress integrity or disruption; lesser trochanter location, varus or valgus deformities, and flexion or extension of the proximal fragment.


RESULTS
Association between open reduction and the following types of fractures was statistically significant (p<0.001): subtypes A2.3, A3.2 and A3.3 of AO classification and subtypes IV and V of Evans classification. There were four radiological parameters associated with the need for open reduction: disruption of lateral wall (p<0.0000), posterior wall fracture (p<0.001), calcar (p<0.004) and malalignment in the axial view (p<0.001).


CONCLUSIONS
Open reduction seems to be necessary for complex fracture patterns such as A2.3, A3.2 and A3.3 types of AO/OTA classification, as well as types IV and V of Evans classification. There are four major radiological parameters that can predict the need of approaching the fracture site: posterior buttress, calcar disruption, lateral wall disruption and proximal fragment flexion. The development of high quality evidence regarding this topic is necessary due to the vast impact that open reduction can have on elderly patients.
Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: veronica.jimenez.diaz@gmail.com.
Verónica Jiménez
VJ
Díaz
Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
Alfonso Carlos Prada
AC
Cañizares
Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
Ismael Auñón
IA
Martín
Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
Miguel Aroca
MA
Peinado
Department of Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
Pedro Caba
PC
Doussoux
D000058:Accidental Falls; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006620:Hip Fractures / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
Elderly; Fixation; Intertrochanteric fracture; Open approach; Predictive variables; Proximal femoral nail; Reduction; Unstable