Mounisamy Prabu, Suresh Hanoop, Chandrashekar Sushma, D Udayakumar, Jeyaraman Naveen, Jeyaraman Madhan, Muthu Sathish
Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
Department of Orthopaedics, Sri Manakula Vinayagar Medical College and Hospital, Puducherry 605107, India.
World J Orthop. 2025 Apr 18;16(4):106862. doi: 10.5312/wjo.v16.i4.106862.
In intertrochanteric fractures, the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.
To analyze the concept of medial cortical reduction (MCR) and its clinical and radiological association in geriatric intertrochanteric femur fractures.
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.
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 ( = 0.883) as that of the time to full weight bearing ( = 0.789).
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.
在转子间骨折中，内侧皮质支撑复位阳性被认为可提供一种有助于控制塌陷的非解剖性支撑。
分析老年股骨转子间骨折的内侧皮质复位（MCR）概念及其临床和影像学关联。
本前瞻性队列研究纳入了2021年7月至2023年6月期间出现AO/OTA 31A1和31A2型股骨骨折并接受股骨近端髓内钉治疗的老年患者。根据MCR程度，将他们分为阳性、中性或阴性MCR组。在术后6周、12周和24周分析人口统计学基线特征、术后影像学股骨颈干角和颈长。还分析了功能结果，如改良Harris髋关节评分（HHS）和完全负重时间。
本研究纳入了47例患者（男:女=35:12），平均年龄65.8±4.2岁。术后22例内侧皮质为中性支撑，9例为阴性支撑，16例为阳性支撑。三组的基线特征具有可比性。术后各组间股骨颈长度和股骨颈干角变化无显著差异。改良HHS组间差异无统计学意义（P=0.883），完全负重时间组间差异也无统计学意义（P=0.789）。
基于内侧皮质对线实现的复位类型不影响股骨颈长度缩短或内翻塌陷。未来需要进行随机对照试验来验证本研究中的发现。
