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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Cortical Support in Unstable Intertrochanteric Fracture without Fixation of Posteromedial Fragment
Ki-Tae Park1, Dong-Hoon Lee2, Kyung-Hoi Koo3,4
1Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Clinics in Orthopedic Surgery
|June 2, 2026
Summary
Fixing large posteromedial fragments in unstable intertrochanteric fractures is not always necessary. Achieving adequate cortical support (CS) during intramedullary nailing is crucial for preventing fracture site collapse and ensuring good surgical outcomes.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Biomechanics
Background:
- The posteromedial (PM) buttress is vital for stability in unstable intertrochanteric (INT) fractures.
- The necessity of fixing large PM fragments in these fractures remains debated.
- This study investigates outcomes without PM fragment fixation in unstable INT fractures treated with intramedullary nailing.
Purpose of the Study:
- To assess surgical outcomes, specifically fracture site collapse and fixation failure, in patients with unstable INT fractures and large PM fragments who did not undergo PM fragment fixation.
- To compare outcomes between patients with and without cortical support (CS) after intramedullary nailing.
Main Methods:
- Retrospective analysis of 658 hip fracture surgeries.
- Included 157 patients with unstable INT fractures without PM fragment fixation, followed for at least 6 months.
- Classified patients into non-cortical support (non-CS) and cortical support (CS) groups based on reduction quality.
Main Results:
- Overall, 40.8% experienced fracture site collapse, 3.2% had fixation failure, and 1.3% developed posttraumatic osteonecrosis of the femoral head (ONFH).
- Reoperation was needed in 2.5% of cases.
- Fracture site collapse was significantly more frequent in the non-CS group (48.7%) compared to the CS group (32.9%) (p=0.044).
Conclusions:
- Fixation failure in unstable INT fractures without PM fragment fixation was 3.2% and linked to inadequate reduction, particularly the absence of CS.
- Achieving optimal cortical support (CS) through appropriate fracture reduction is critical for successful surgical outcomes.
