Incidence, predictors, and impact of valgus reduction of traumatic intertrochanteric femoral fractures (OTA 31A1-3) treated with the helical blade system: Is anatomic reduction necessary? A retrospective case series

Abstract

Background:The purpose of this study was to describe the incidence and variables contributing to valgus distraction following cephalomedullary fixation of intertrochanteric femoral fractures with the helical blade system and to determine whether the resulting valgus reduction affected outcomes.Methods:We performed a retrospective case review of cephalomedullary fixation of intertrochanteric femoral fractures between 2009 and 2016. Patients treated with the helical blade system and with at least 6 mo of follow-up were included. Demographic, injury, and surgical variables were extracted from the medical record. At final follow-up complications, including implant failure, blade migration, cut-out, periprosthetic fracture, and reoperation were recorded.Results:Overall, 68 consecutive patients with unilateral intertrochanteric hip fractures were included. Postoperative radiographs demonstrated valgus reduction in 30 (44.1%) patients. At final follow-up, all fractures attained uneventful union. No patient experienced periprosthetic fracture or helical blade cut-out by the time of union and final follow-up. Two patients experienced postoperative infections, both requiring reoperation. Multivariate analysis revealed that only age was marginally predictive of valgus distraction (P=0.061), while fracture stability and blade position were not. Valgus reduction was not predictive of blade migration.Conclusions:Valgus distraction occurred in nearly half (44%) of the patients. While younger age was marginally predictive of this phenomenon, fracture stability and helical blade position were not. Furthermore, valgus reduction had no influence on the presence or degree of blade migration, cut-out, or complications. Therefore, while anatomic reduction may yield aesthetic appeal, time and effort should not be expended on direct anatomic reduction.Level of Evidence:Level IV.