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Updated: Jun 2, 2026
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Effect of Lesser Trochanter Fragment Union on Functional and Radiological Outcomes After Intramedullary Nailing of
Lalremsanga Chhangte1, Vijay Kumar Jain1, Abdus Sami1
1Department of Orthopedics, Atal Bihari Vajpayee Institute of Medical Sciences Dr. Ram Manohar Lohia Hospital, New Delhi, 110001 India.
Background:
Displaced lesser trochanter (LT) fragments are common in unstable intertrochanteric fractures and may compromise posteromedial stability. However, the clinical relevance of LT fragment union after intramedullary nailing remains unclear.
Methods:
This prospective observational study included 72 adults with intertrochanteric fractures and displaced LT fragments treated with intramedullary nailing. LT fragment morphology (displacement, rotation, fragment number) was quantified on preoperative CT scans. Outcomes included radiographic healing, assessed using the modified Radiographic Union Score for Hip (mRUSH), and functional recovery, assessed using the modified Harris Hip Score (mHHS) at 1, 3, and 12 months. Patient factors, including serum vitamin D levels, smoking status, and comorbidities, were analysed for association with LT non-union.
Results:
At 12 months, patients with LT union had significantly higher mHHS (p = 0.003) and mRUSH (p = 0.003) scores, whilst VAS pain scores were similar (p = 0.832). LT non-union was associated with greater displacement (p < 0.001), greater rotation (p < 0.001), multiple fragments (p < 0.001), lower vitamin D levels (p = 0.009), smoking (p = 0.010), and hypertension (p = 0.031).
Conclusion:
LT fragment union after intramedullary nailing is associated with improved functional recovery and radiographic healing. Preoperative CT-based assessment of LT morphology and optimization of modifiable risk factors (vitamin D, smoking, hypertension) may improve outcomes.