Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle

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Abstract

Objectives:

To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout.

Design:

Retrospective comparative study.

Setting:

Level I trauma center.

Patients/Participants:

Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014.

Intervention:

CMN fixation.

Main Outcome Measurement:

NSA reduction and lag screw cutout.

Results:

Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), −63% to −18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%–46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%–49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, −56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, −13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, −24% to 44%; P = 1.0).

Conclusions:

The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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