Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 6, pp 839–846 | Cite as

Postoperative stability on lateral radiographs in the surgical treatment of pertrochanteric hip fractures

  • Sachiyuki TsukadaEmail author
  • Go Okumura
  • Munenori Matsueda
Osteoporotic Fracture Management



Fixed-angle sliding hip-screw devices are commonly used to treat pertrochanteric fractures. The controlled impaction between the head and neck fragment and the femoral shaft fragment is crucial. However, the poor quality of fracture reduction can intercept controlled impaction and lead to excessive sliding. We hypothesized that excessive sliding occurs when most of the impaction is placed on the fragile posterior cortex of the fracture site.


This retrospective study included 128 AO/OTA type 31-A1 or 31-A2 fractures treated with fixed-angle sliding hip-screw devices. Cases involving reduced continuity of the anterior cortex at fracture site were defined as Type 1, those involving head and neck fragment anteriorly displaced relative to the femoral shaft fragment as Type 2, and those involving head and neck fragment posteriorly displaced relative to the femoral shaft fragment as Type 3. The extent of postoperative sliding distance of lag screw was measured.


There were 52 cases of Type 1, 30 of Type 2, and 46 of Type 3, with no differences in patient characteristics between types. The mean ± standard deviation extent of sliding for types 1–3 was 4.5 ± 4.9 mm, 7.8 ± 5.6 mm, and 11.1 ± 6.0 mm, respectively (p < 0.0001). Sliding was significantly greater for Type 3 cases than for Type 1 or 2 (p < 0.0001 and p = 0.044, respectively).


Excessive sliding occurs in surgical treatment for pertrochanteric fractures with posterior displacement of the head and neck fragment. In such cases, we recommend appropriate reduction prior to internal fixation.


Hip fracture Trochanteric Sliding Reduction Lateral radiograph 



The procedures disclosed in this study comply with the current laws of Japan.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–1288PubMedCrossRefGoogle Scholar
  2. 2.
    Melton LJ 3rd, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, Therneau TM, Leibson CL (2009) Secular trends in hip fracture incidence and recurrence. Osteoporos Int 20:687–694PubMedCrossRefGoogle Scholar
  3. 3.
    Lüthje P, Santavirta S, Nurmi I, Honkanen R, Heiliövaara M (1993) Increasing incidence of hip fractures in Finland. Arch Orthop Trauma Surg 112:280–282PubMedCrossRefGoogle Scholar
  4. 4.
    Davis TRC, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG (1990) Intertrochanteric femoral fractures: mechanical failure after internal fixation. J Bone Joint Surg Br 72:26–31PubMedGoogle Scholar
  5. 5.
    Jensen JS, Sonne-Holm S, Tøndevold E (1980) Unstable trochanteric fractures: a comparative analysis of four methods of internal fixation. Acta Orthop Scand 51:949–962PubMedCrossRefGoogle Scholar
  6. 6.
    Buciuto R, Hammer R (2001) RAB-plate versus sliding hip screw for unstable trochanteric hip fractures: stability of the fixation and modes of failure—radiographic analysis of 218 fractures. J Trauma 50:545–550PubMedCrossRefGoogle Scholar
  7. 7.
    Parker MJ (1996) Trochanteric hip fractures. Fixation failure commoner with femoral medialization, a comparison of 101 cases. Acta Orthop Scand 67:329–332PubMedCrossRefGoogle Scholar
  8. 8.
    Carr JB (2007) The anterior and medial reduction of intertrochanteric fractures: a simple method to obtain a stable reduction. J Orthop Trauma 21:485–489PubMedCrossRefGoogle Scholar
  9. 9.
    Ebbinghaus S, Mjöberg B (1991) Posterior angulation in trochanteric fractures detected with roentgen stereophotogrammetry. Ups J Med Sci 96:235–237PubMedCrossRefGoogle Scholar
  10. 10.
    Ikuta T (2004) Compression hip screw fixation for proximal femoral fractures. J Joint Surg 23:1585–1594 In JapaneseGoogle Scholar
  11. 11.
    Fracture and dislocation compendium (1996) Orthopaedic trauma association committee for coding and classification. J Orthop Trauma 10:1–154CrossRefGoogle Scholar
  12. 12.
    Hiranaka T, Chinzei N, Hida Y, Tsuji M (2011) Accurate measurement of the sliding length of femoral head fixation devices of intramedullary nail for trochanteric fractures. Kossetsu 33:652–654 In JapaneseGoogle Scholar
  13. 13.
    Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77:1058–1064PubMedGoogle Scholar
  14. 14.
    Owens WD, Felts JA, Spitznagel ELJ (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243PubMedCrossRefGoogle Scholar
  15. 15.
    Salvati EA, Wilson PDJ (1973) Long-term results of femoral-head replacement. J Bone Joint Surg Am 55:516–524PubMedGoogle Scholar
  16. 16.
    Evans EM (1951) Trochanteric fractures: a review of 110 cases treated by nail-plate fixation. J Bone Joint Surg Br 33:192–204Google Scholar
  17. 17.
    Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Toshizuka T (1959) A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg Am 41:1339–1408Google Scholar
  18. 18.
    Taylor GM, Neufeld AJ, Nickel VL (1955) Complications and failures in the operative treatment of intertrochanteric fractures of the femur. J Bone Joint Surg Am 37:306–316PubMedGoogle Scholar
  19. 19.
    Clawson DK (1964) Trochanteric fractures treated by the sliding screw plate fixation method. J Trauma 4:732–752CrossRefGoogle Scholar
  20. 20.
    Kyle RF, Gustilo RB, Premer RF (1979) Analysis of six hundred and twenty-two intertrochanteric hip fractures: a retrospective and prospective study. J Bone Joint Surg Am 61:216–221PubMedGoogle Scholar
  21. 21.
    Bendo JA, Weiner LS, Strauss E, Yang E (1994) Collapse of intertrochanteric hip fractures fixed with sliding screws. Orthop Rev (Suppl):30–37Google Scholar
  22. 22.
    Kawatani Y, Nishida K, Anraku Y, Kunitake K, Tsutsumi Y (2011) Clinical results of trochanteric fractures treated with the TARGON proximal femur intramedullary nailing fixation system. Injury 42:S22–S27PubMedCrossRefGoogle Scholar
  23. 23.
    Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P (2007) Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am 89:470–475PubMedCrossRefGoogle Scholar
  24. 24.
    Im GI, Shin YW, Song YJ (2005) Potentially unstable intertrochanteric fractures. J Orthop Trauma 19:5–9PubMedCrossRefGoogle Scholar
  25. 25.
    Hardy DC, Descamps PY, Krallis P, Fabeck L, Smets P, Bertens CL, Delince PE (1998) Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures: a prospective, randomized study of one hundred patients. J Bone Joint Surg Am 80:618–630PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sachiyuki Tsukada
    • 1
    Email author
  • Go Okumura
    • 2
  • Munenori Matsueda
    • 2
  1. 1.Department of Orthopedic SurgeryKawaguchi Kogyo General HospitalKawaguchiJapan
  2. 2.Department of Orthopedic SurgeryNiigata Central HospitalNiigataJapan

Personalised recommendations