Incidence and Radiologic Outcome of Intraoperative Lateral Wall Fractures in OTA 31A1 and A2 Fractures Treated With Cephalomedullary Nailing

Objectives: To determine the incidence of intraoperative lateralwall fracture in OTA 31A1 and A2 fractures treated with a cephalomedullary nail and to determine whether this contributed to the failure of treatment. Design: Retrospective review. Setting: University hospital. Patients/Participants: A cohort of 291 patients (31.A1/A2-231, A3-60) was assessed with pre-and postoperative radiographs. Patients with intact lateral wall fractures were included in the study. One hundred sixty-five of 231 patients (77%) completed radiologic follow-up. They were divided into 2 groups. Group 1 (129 patients, 78%) consisted of patients with an intact lateral wall postoperatively. Group 2 (36 patients, 22%) consisted of patients who sustained lateral wall fracture intraoperatively (FLW). Intervention: Closed reduction and intramedullary nail insertion. Main Outcome Measurements: Rate of failure/reoperation and collapse were compared between the groups. Results: The incidence of intraoperative lateral wall fracture was 21% (48 of 165). Fracture collapse and failure rate were not statistically significant in either groups (group 1: 1%, group 2: 5%). Conclusions: The incidence of intraoperative lateral wall fracture in OTA 31A1 and A2 pertrochanteric fractures after cephalomedullary nailing is similar to sliding hip screws. The presence of lateral wall fracture did not adversely affect healing of pertrochanteric fractures.