Proximal Femoral Lateral Wall Thickness as a Predictor of Fixation Outcome in Stable Intertrochanteric Fractures: A Prospective Cohort Study | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 158, Volume 100, Issue 1, July 2025, Page 3644-3650 PDF (851.32 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2025.447688 | ||||
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| Abstract | ||||
| Background: The integrity of the proximal femoral lateral wall is increasingly recognized as a critical determinant of stability in intertrochanteric fractures, with its compromise frequently leading to higher complication rates. Objective: This study aimed to evaluate predictive role of preoperative lateral wall thickness in the outcome of stable intertrochanteric fracture fixation and to compare the functional results of Dynamic Hip Screw (DHS) versus Proximal Femoral Nail (PFN) fixation. Methods: A prospective cohort study was conducted at Suez Canal University Hospitals on 65 patients presenting with stable intertrochanteric fractures (Evans stable Type 1, corresponding to AO type 31-A1.1 to 31-A2.1). Postoperative outcomes, including lateral wall fracture incidence and functional status via Harris Hip Score (HHS), were assessed. Results: Postoperative lateral wall fractures occurred in 24 patients (36.9%). A significantly higher incidence was observed in the DHS group compared to the PFN group. Post-injury HHS was significantly better in the PFN group compared to the DHS group. The overall mean pre-injury HHS was 91.66 ± 1.5, which significantly decreased to 73.42 ± 8.98 post-injury. Complications included varus malunion (18.5%), implant failure due to cut-through (3.1%), and shortening (20%). Conclusion: Preoperative lateral wall thickness serves as an accurate predictor of postoperative lateral wall fracture. Maintaining lateral wall integrity is crucial during fixation to minimize complications. For stable intertrochanteric fractures with a preoperative lateral wall thickness below 20.5 mm, PFN fixation is associated with a lower rate of postoperative lateral wall fracture and superior functional outcomes compared to DHS. | ||||
| Keywords | ||||
| Lateral wall thickness; Intertrochanteric fractures; Harris Hip Score; DHS; PFN | ||||
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