Outcomes of Low-Energy Basicervical Proximal Femoral Fractures Treated with Cephalomedullary Fixation

Background: Basicervical peritrochanteric fractures are relatively rare, with 1.8% to 7.6% of hip fractures being identified as true basicervical fractures. The compression hip screw traditionally has been considered the "gold standard" for operative fixation of peritrochanteric fractures, with generally good results. The purpose of this study was to report the outcomes of basicervical peritrochanteric fractures of the proximal part of the femur treated with cephalomedullary nailing (CMN). Methods: We reviewed medical records and radiographs of all patients at our institution with a peritrochanteric fracture treated with CMN from 2010 to 2012 (246 patients). Fourteen patients with a 2-part basicervical fracture were identified. Two of them died less than 6 weeks after injury and another patient did not return for follow-up. Eleven patients were included in the reported series. Results: Five of the 11 patients had fracture-healing without complications. Their average tip-apex distance was 14.9 mm. The fixation failed in the remaining six patients, all of whom had a tip-apex distance of < 25 mm, with an average of 17.4 mm. Four of the failures followed an anatomic reduction, and the other 2 followed a nearly anatomic reduction. Conclusions: CMN may be inadequate for fixation of 2-part basicervical fractures.