Abstract: Background:Reverse obliquity intertrochanteric fracture is a challenging injury encountered by orthopaedic surgeons. The patients are usually osteoporotic, with multiple co-morbidities and poor tolerance for complications and re-operations. In such a difficult scenario an intramedullary nail is recommended to give a stable fixation. This study aims to compare results between fracture fixation by only intramedullary nailing and nailing with augmentation by cerclage wires.
Material and Methods:This prospective study includes 53 patients from August 2016 to September 2018 that presented to our institute with a reverse obliquity intertrochanteric fracture. They were sequentially operated with either intramedullary nailing (IMN) or nailing with additional use of cerclage wires. Patients were followed up for a minimum of 12 months. Radiological union time, complications and functional outcome (using Harris Hip Score) were noted at 1 year. Statistical analysis was performed to compare the results in both groups.
Results:The mean union time was 4.3±0.534 months in Group A and 3.8±0.534 months in group B. The mean operating time needed for cerclage-augmentation was 10 minutes more than IMN only. The incidence of complications like screw cut out, back out and non-union, re-operation rate was lower in cerclage group. But the incidence of deep infection at the fracture site was more in cerclage group. Cerclage group had good functional outcome which was statistically significant.
Conclusions:The technique of using cerclage wires in addition to intramedullary nail in reverse obliquity intertrochanteric fractures for lateral wall reconstruction provides good radiological and functional outcomes. It also reduces many complications of the procedure. Only concerning factor remains the increased risk of infection at the fracture site.
