Mounisamy P, Suresh H, Chandrashekar S, D U, Jeyaraman N, Jeyaraman M, Muthu S. Medial cortical reduction does not influence outcomes in geriatric intertrochanteric femur fractures treated with proximal femoral nail. World J Orthop 2025; 16(4): 106862 [DOI: 10.5312/wjo.v16.i4.106862]
Corresponding Author of This Article
Madhan Jeyaraman, MD, PhD, Assistant Professor, Research Fellow, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Velappanchavadi, Chennai 600077, Tamil Nadu, India. madhanjeyaraman@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Prabu Mounisamy, Hanoop Suresh, Sushma Chandrashekar, Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Udayakumar D, Department of Orthopaedics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry 605107, India
Naveen Jeyaraman, Madhan Jeyaraman, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
Naveen Jeyaraman, Madhan Jeyaraman, Sathish Muthu, Department of Orthopaedics, Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India
Author contributions: Mounisamy P, Suresh H, and Jeyaraman M contributed to conceptualization; Mounisamy P, Suresh H, and Chandrashekar S contributed to acquiring clinical data and performing the data analysis; Jeyaraman N, Suresh H, Muthu S and Jeyaraman M contributed to manuscript writing; Mounisamy P, Muthu S, and Jeyaraman M helped in manuscript revision, contributed to administration; Mounisamy P, Udayakumar D contributed for image acquisition; Jeyaraman M contributed to proofreading. All authors have agreed to the final version to be published and agree to be accountable for all aspects of the work.
Institutional review board statement: Ethical approval has been obtained (JIP/IEC-OS/125/2022 dated 01.10.2023).
Informed consent statement: All participants consented to participate in the study and informed consent was obtained from each participant.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Data sharing statement: All data is contained within the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Madhan Jeyaraman, MD, PhD, Assistant Professor, Research Fellow, Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Velappanchavadi, Chennai 600077, Tamil Nadu, India. madhanjeyaraman@gmail.com
Received: March 10, 2025 Revised: March 23, 2025 Accepted: April 11, 2025 Published online: April 18, 2025 Processing time: 39 Days and 6.4 Hours
Abstract
BACKGROUND
In intertrochanteric fractures, the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.
AIM
To analyze the concept of medial cortical reduction (MCR) and its clinical and radiological association in geriatric intertrochanteric femur fractures.
METHODS
Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study. Based on the degree of MCR, they were divided into positive, neutral, or negative MCR groups. The demographic baseline characteristics, postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6, 12 and 24 weeks post-surgery. Functional outcomes such as modified Harris Hip Score (HHS) and time to full-weight bearing were also analyzed.
RESULTS
47 patients (Male: Famale 35:12) with mean age of 65.8 ± 4.2 years were included in this study. Twenty-two cases had neutral support, nine had negative support, and sixteen had positive support in the medial cortex post-operatively. Baseline characteristics of the three groups were comparable. No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups. The modified HHS was not found to be significant between the groups (P = 0.883) as that of the time to full weight bearing (P = 0.789).
CONCLUSION
The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse. Future randomized controlled trials are needed to validate the findings noted in the study.
Core Tip: In this prospective cohort study, 47 geriatric patients with AO/OTA 31A1 and 31A2 femur fractures treated with proximal femoral nailing were analyzed based on medial cortical reduction (MCR). They were divided into positive, neutral, or negative MCR groups. The study found no significant differences in femur neck length shortening, neck-shaft angle changes, modified Harris Hip Scores, or time to full weight-bearing among the groups. MCR alignment does not affect femur neck length or varus collapse. Future randomized trials are needed to validate these findings.
