Abstract
Introduction
The reverse obliquity fractures of the proximal femur are anatomically and mechanically different from most intertrochanteric fractures. These fractures are complex and very difficult to treat. To evaluate the results of the treatment of reverse obliquity intertrochanteric fractures with cephalomedullary nails.
Materials and Methods
Between 2005 and 2009, 1179 extracapsular fractures of the proximal femur were treated at our institution. Retrospective review of these x-rays identified 59 patients with reverse obliquity fracture pattern. We analysed our results of cephalomedullary nailing of these complex fractures and evaluated factors responsible for failure of fixation.
Results
Of the 59 patients with reverse oblique fracture pattern, one patient was treated with DHS, and two other patients didn't have post-operative x-rays and therefore were excluded from the study. Of the remaining 56 patients treated with cephalomedullary nails, forty eight were treated with gamma nails, five with PFNA and three with ATN. There were 40 females and 16 males with median age of 81.3 years (17–103 years). Six of the fifty six (10.7%) failed to heal or had failure of fixation. The failure rate was four of forty eight for the gamma nails, one of five of the PFNA and one of three of ATN. One of thirty seven (2.7%) of anatomically reduced fractures and five of nineteen (26.3%) of non-anatomically reduced fractures had failure of treatment (p = 0.01). Three of thirteen (23.1%) with femoral medialisation and three of forty three (6.9%) without femoral medialisation had failure of treatment (p = 0.13). Four of forty four (9.1%) with avulsed lesser trochanter and two of twelve (16.6%) without avulsion had failure of treatment (p = 0.59). Three of thirty seven (8.1%) with tip apex distance (TAD) of less than twenty and three of nineteen (15.7%) with TAD more than twenty had failure of treatment (p = 0.65).
Conclusion
Inspite of the recent advances in the methods of internal fixation available to surgeons, reverse obliquity intertrochanteric fractures continue to be a challenge for orthopaedic surgeons. In our study, although poor fracture reduction was observed to be the only significant factor associated with a high failure rate, femoral medialisation and tip apex distance of more than 20 had a high association with poor outcome.
