Technical Pearl: Watch Out for Anterior Malreduction When Fixing Intertrochanteric Hip Fractures

A new, independent risk factor for hip screw cutout

What’s the Claim?

In a large, multicenter radiographic analysis of intertrochanteric hip fractures in patients over the age of 65 whose hips were fixed with a cephalomedullary nail or a sliding hip screw, authors found that a tip-apex distance (TAD) ≥ 20 mm was associated with cutout (no surprise) and that:

  • Postoperative sliding of the compression screw ≥ 6 mm within 2 weeks of surgery was associated with cutout, and
  • Anterior malreduction, a factor directly within the surgeon’s control, was also associated with cutout (adjusted OR 4.2, 95% CI 1.5 to 12)

The authors used the oblique lateral radiograph to define anterior malreduction. On that view, it occurs when the anterior cortex of the neck fragment is positioned anywhere posterior to the anterior cortex of the diaphyseal fragment.

How’s It Stack Up?