Intertrochanteric Fractures: Lateral Wall Fractures

The status of the lateral femoral cortex in an intertrochanteric fracture is a significant determinant of postreduction fracture stability. The lateral cortex provides a buttress that allows for interfragmentary compression. Recently, it has been demonstrated that lateral wall fractures are a potential intraoperative iatrogenic complication that can lead to a prolonged, painful recovery. ¹ The etiology of these fractures is related to the initial fracture pattern, implant selection, surgical technique, and patient characteristics (Table 23-1). The incidence of lateral wall fractures has been reported to be 3% in AO/OTA type A1-A2.1 fractures and 31% in AO/OTA type A2.2 or A2.3 (Figure 23-1). ² These higher grade fractures have more comminution and less lateral wall bone stock. The status of the lateral wall largely determines the modality of fixation that may be employed (ie, sliding hip screw with side plate versus a fixed-angle device). Finally, fractures of the lateral cortex can occur with improper surgical technique, including poor entry angle of drill, improper screw alignment in the predrilled path, large bore screws, and multiple perforations of cortex during reaming (see Table 23-1). ².