• Kenta Momii, Toshifumi Fujiwara, Takao Mae, Masami Tokunaga, Takeshi Iwasaki, Kyohei Shiomoto, Kensuke Kubota, Toshihiro Onizuka, Tatsuhiko Miura, Takahiro Hamada, Tetsuro Nakamura, Takashi Itokawa, Takahiro Iguchi, Akihisa Yamashita, Naoshi Kikuchi, Kazutoshi Nakaie, Yoshihiro Matsumoto, and Yasuharu Nakashima.
• Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
• Injury. 2021 Nov 1; 52 (11): 3369-3376.

IntroductionThe application of a load on the internal fixation of a trochanteric fracture exerts a moment along the lag screw, causing the proximal bone fragment to slide along the lag screw, allowing contact between the proximal and distal bone fragments, which promotes healing. However, excessive sliding is related to poor postoperative outcomes. We aimed to identify the risk factors for excessive sliding.Materials And MethodsWe conducted a multicenter retrospective study including 115 trochanteric fractures sustained through low-energy trauma in 19 male and 96 female patients aged 60 years or older (mean age: 82.9 years) between September 2013 and December 2014. We measured the postoperative sliding distance after osteosynthesis using a sliding hip screw or intramedullary nailing, and classified participants with ≥8 mm of sliding into the excessive sliding group (ESG) and with <8 mm into non-ESG. Finally, we investigated the risk factors of excessive postoperative sliding.ResultsFifty participants were classified into the ESG and 65 participants into the non-ESG. Female sex (p = 0.0264), an A3 fracture type (p = 0.0003), greater tip-apex distance (p = 0.0250), and poor reduction in either the anteroposterior or lateral radiographic views (p = 0.0156) were identified as risk factors for excessive sliding by multivariate regression analysis.ConclusionsFemale sex, an unstable fracture type, a greater tip-apex distance, and a poor reduction, in either the anteroposterior or lateral views, are associated with excessive postoperative sliding. Therefore, surgery should aim to achieve good reduction and stabilization from both radiographic views.Copyright © 2021. Published by Elsevier Ltd.

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