Morphology Specific Lateral Wall Reconstruction Techniques Using Cerclage Wires in Unstable Trochanteric Fractures

Abstract

Trochanteric lateral wall fracture (LWF) indicates instability and is found to be an important predictor of reoperations fol-
lowing trochanteric fracture fxation. A single unifed technique for lateral wall reconstruction may not adequately stabilize
all the fracture patterns. We have presented morphology specifc lateral wall reconstruction techniques using cerclage wire around proximal femoral nails. Various LWF patterns have been simplifed into three types. Type-specifc lateral wall recon-
struction techniques using cerclage wire were adopted in 49 consecutive unstable trochanteric fractures presented to our
institute between 2016 and 2018. We analyzed the fracture pattern, fxation method used, union time, and complications.
The functional outcome was analyzed using the Harris hip score (HSS). The mean follow-up period was 13 months (range
10–36 months). The mean age of the population was 66 years (range 36–91 years). There were 15 patients with type 1 LWF
pattern, 26 patients with type 2, and 8 were of type 3 pattern. The mean operating time was 66 min. The mean union time
was 14 weeks (10–24 weeks). HSS was excellent in 9 patients, good in 33 patients, fair in 4 patients, and poor in 5 patients.
Complications include one patient with avascular necrosis (AVN) of the femoral head, varus collapse with non-union in one
patient, screws back out in one patient, superfcial infection in 4 patients, and distal screw breakage in one patient. Type 2
is the most common LWF type in our study. In unstable trochanteric fractures, morphology specifc lateral wall reconstruc-tion using cerclage wire loops around the proximal femoral nail is a simple technique with promising results with minimalcomplications.