The aim of this study was to determine if femoral medialization
influences residual pain
and to determine if fixation method or fracture pattern influences the tendency to medialize.
This study used data from within a randomized controlled trial.
Peterborough City Hospital, UK.
Eight 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.
Randomized to fixation with a Targon proximal femoral nail or sliding hip screw
Outcome Measures: Femoral medialization
was calculated from follow-up x-rays at a minimum of 28 days post-fixation. Pain
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.
Patients with >50% medialization had worse pain
= 0.012) and mobility
= 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
< 0.001). A2 and A3 fractures were more likely to medialize, and A3 fractures were more likely to undergo >50% medialization (P
Our 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 Evidence:
Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.