• Christopher P Bretherton and Martyn J Parker.
• *Trauma Unit, John Radcliffe Hospital, Oxford, United Kingdom; and†Department of Orthopaedic, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom.
• J Orthop Trauma. 2016 Dec 1; 30 (12): 642-646.

ObjectivesThe aim of this study was to determine if femoral medialization influences residual pain and mobility and to determine if fixation method or fracture pattern influences the tendency to medialize.DesignThis study used data from within a randomized controlled trial.SettingPeterborough City Hospital, UK.Patient/ParticipantsEight hundred forty-four patients presenting with a trochanteric hip fracture were randomized. Five hundred thirty-eight were available for 1-year follow-up. Fractures were classified according to OTA/AO classification as 31 A1, A2, and A3.InterventionRandomized to fixation with a Targon proximal femoral nail or sliding hip screw (SHS).Outcome MeasuresFemoral medialization was calculated from follow-up x-rays at a minimum of 28 days post-fixation. Pain and mobility scores were assessed at 1 year by an independent blinded observer. Fixation failure and revision procedures were assessed at a minimum of 1 year from injury.ResultsPatients with >50% medialization had worse pain (P = 0.012) and mobility scores (P = 0.013) at 1 year. They also had more fracture healing complications (P = 0.021) and required more revision procedures (P = 0.014). Fractures treated with SHS were more likely to medialize >50% compared with intramedullary nail (P < 0.001). A2 and A3 fractures were more likely to medialize, and A3 fractures were more likely to undergo >50% medialization (P < 0.001).ConclusionsOur study demonstrates the previously theoretical predisposition for unstable hip fractures treated with SHS to undergo femoral medialization and correlates this with worse functional outcomes. It supports the use of intramedullary nails for A3 fractures, which have a significant tendency to medialize.Level Of EvidencePrognostic level II. See Instructions for Authors for a complete description of levels of evidence.

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