Results of sagittaly unstable intertrochanteric fractures managed by dual reduction technique


  • Anoop Kalia Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab, India
  • Gaurav Saini Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab, India
  • Isha Sharma Department of Anaesthesia, Fortis Hospital, Amritsar, Punjab, India
  • Sagar Kadam Department of Orthopaedics, Max Super Speciality Hospital, Mohali, Punjab, India



Intertrochanteric, Nail, Reduction


Background: We evaluated the functional and radiological outcome of sagittally unstable intertrochanteric fractures reduced by dual technique consisting of a crutch placed posteriorly over distal fragment and pushing the flexed proximal fragment by ramrod anteriorly over a period of 12 months.

Methods: A fracture was defined as sagittally unstable intertrochanteric fracture when posterior sagging of distal fragment and flexion of proximal fragment worsens after routine maneuvers for closed reduction. Out of the 80 intertrochanteric fractures treated from February 2018 to April 2019, 16 hips had sagittal instability and after reduction were treated with proximal femoral nail (Stryker Trauson) in some patients and DePuy Synthes proximal femoral nail PFNA in remaining patients. These 16 patients were followed up for a period of 1 year and functional and radiological outcome was noted.

Results: Out of the 16 patients, 10 were males and 6 were females. The mean age was 68.2 years. According to the A.O classification out of the 16 patients, 7, 5 and 4 patients were classified as A1.3, A2.1, and A2.2 or more. The mean time from injury till surgery was 4.6 days. The mean surgical time was 45.8 minutes. The mean time for radiological union was 22.4 weeks. The mean pre injury activity level was 4.2 while the mean final activity level was 3.8 (1-5) according to modified Koval activity index.

Conclusions: Anatomical reduction followed by rigid internal fixation is the key to success in intertrochanteric fractures. 


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