Assessing the Importance of Anteromedial Cortical Support in Fixing Pertrochanteric Fractures: A Comprehensive Study

Pertrochanteric fractures are among the most common hip fractures in the elderly population, typically resulting from low-energy trauma such as a simple fall. This demographic is particularly susceptible due to factors like decreased bone density, frailty, and impaired balance. It can occur in the younger patient due to high-velocity trauma - road traffic accidents. Medial cortical support (MCS) reduction is a key element, as it allows limited sliding of head-neck fragments and it provides good fracture healing and MCS acts as non-anatomic buttress reduction providing secondary stability.

This is a prospective single study center cohort which includes 40 patients undergoing treatment for an unstable pertrochanteric fracture using Proximal Femoral Nail A2 (PFN A2) admitted in the Department of Orthopedics, Government Thoothukudi Medical College Hospital, Tamil Nadu from June 2019 to September 2024, for a follow-up period for a maximum of 18-24 months.

In our study, outcome analysis was assessed by Harris hip scoring system 56% which showed excellent results, 24% good, 12% shows fair, and other 8% bad outcome. In this series, 21 cases were fixed in positive cortical support, 15 cases in neutral support, and 4 cases in negative cortical support. We noticed varus malunion in 2 cases and 1 case of delayed union and 1 case of screw pullout in the negative cortical support group.

Positive and neutral medial cortical support was noticed to produce a stronger buttress effect in both the anteroposterior and lateral views. It is recommended to acquire the maximum amount of positive support reduction during a procedure for unstable pertrochanteric fractures because it improves mechanical stability.