• Richard F Kyle, Thomas J Ellis, and David C Templeman.
• Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN 55415, USA. richard.kyle@co.hennepin.mn.us
• J Orthop Trauma. 2005 Jan 1; 19 (1): 1-4.

ObjectiveThe purpose of this study was to report the results of surgical treatment of a subset of intertrochanteric fractures with posteromedial comminution and extension of the fracture line into the femoral neck using a sliding hip screw.DesignRetrospective review.SettingLevel I county trauma center.PatientsTwenty-nine fractures (8%) with this pattern were identified from 381 intertrochanteric hip fractures treated at a single institution over a 10-year period. Nine patients were excluded (2 died, 7 had incomplete radiographic follow-up), leaving 20 patients for assessment.InterventionAll fractures were treated with a sliding hip screw.Main Outcome MeasurementsRadiographs at a mean follow-up of 17 months were recorded as demonstrating: 1) fixation failure; 2) fracture union; or 3) fracture nonunion. The tip-apex distance, amount of lag screw collapse, screw position in the femoral head, and adequacy of reduction were determined.ResultsTreatment failed according to these radiographic measures in 5 of 20 (25%) fractures. Failures included fracture nonunion (1 case), lag screw cutout (2 cases), and combined nonunion/lag screw cutout (2 cases). All 5 failures had complete collapse of the lag screw, whereas 4 of the 15 successfully treated fractures had complete collapse. The amount of collapse was significantly greater for the treatment failures (mean, 38 mm) than in the successfully treated hips (mean, 20 mm). There was no significant association between treatment success or failure and tip-apex distance, lag screw position, and adequacy of reduction.ConclusionWe conclude that intertrochanteric hip fractures with associated femoral neck fractures should not be managed with a standard sliding hip screw.

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