The Importance of Neck-Shaft Angle When Treating Intertrochanteric Hip Fractures

Varus may be more important (more harmful) than a long tip-apex distance

What’s the Claim?

A well-matched, large-center comparative study found that among patients treated with a cephalomedullary nail for intertrochanteric hip fractures, it wasn't just the tip-apex distance that mattered; the coronal reduction angle (the amount of residual varus) also was strongly associated with the risk of fixation failure. In fact, when comparing otherwise well-matched patients, residual varus of > 10° was much more likely to be present in those with fixation failure than in those whose fractures healed uneventfully (35% versus 14%); for every 1° of varus relative to the contralateral normal, the odds of fixation failure increased by about 7%.

The authors note that avoiding varus in the neck-shaft angle of the reduction is especially important in patients with a valgus neck-shaft angle in the other hip.

How’s It Stack Up?