Impact of lesser trochanter displacement on hip function following minimally invasive intramedullary nailing for geriatric intertrochanteric fractures

doi:10.12307/2026.408

Abstract

Abstract: BACKGROUND: Percutaneous minimally invasive intramedullary nailing is a common and effective treatment for intertrochanteric fractures in the elderly, effectively avoiding complications. However, intertrochanteric fractures involving the lesser trochanter remain problematic, particularly with lesser trochanteric separation. Due to the diverse types of lesser trochanteric separation, there are few reports on whether lesser trochanteric separation should be fixed.
OBJECTIVE: To investigate the impact of lesser trochanter displacement distance on postoperative functional outcomes in elderly patients with intertrochanteric fractures treated with minimally invasive intramedullary nailing, providing clinical data to determine whether fixation is necessary.
METHODS: A retrospective analysis was conducted on 46 elderly patients with lesser trochanter displacement following intramedullary nailing for intertrochanteric fractures, treated in the Department of Emergency Surgery, Guizhou Provincial People’s Hospital from August 2020 to December 2023. Patients were divided into two groups based on displacement distance: group A [displacement ≥1 cm, n=23; 11 males and 12 females; mean (77.57±8.97) years] and group B [displacement <1 cm, n=23; 7 males and 16 females; mean (79.04±8.74) years]. Postoperative functional outcomes were compared between the two groups, including time to first straight-leg raise, time to first ambulation, fracture healing time, Harris Hip Scores at 1, 2, 3, 6, 9, and 12 months, and final follow-up excellent rate of Harris Hip Scores.
RESULTS AND CONCLUSION: (1) There were no significant differences in preoperative general data between the two groups (P > 0.05). (2) The time to first straight-leg raising (18.44±3.99) days after surgery in group A was significantly longer than that in group B (15.91±3.64) days (P < 0.05). The time to first ambulation (7.83±1.92) days after surgery in group A was significantly longer than that in group B (6.70±1.80) days (P < 0.05). However, there was no significant difference in fracture healing time between the two groups (P > 0.05). (3) At 1, 2, 3, and 6 months after surgery, Harris Hip Scores in group B were significantly higher than those in group A (P < 0.05). There was no significant difference in Harris Hip Scores between the two groups at 9 and 12 months after surgery (P > 0.05). (4) Hip function at last follow-up: 17 patients in group A achieved a Harris Hip Score of 90 or above, with an excellent rate of 74%; 20 patients in group B achieved a Harris Hip Score of 90 or above, with an excellent rate of 87%. There was no significant difference between the two groups (P > 0.05). (5) This suggests that functional recovery within 6 months after surgery varies among elderly patients with intertrochanteric fractures and differing lesser trochanteric displacement. Beyond 6 months after surgery, a displaced lesser trochanter does not affect hip function. Therefore, routine surgical fixation of displaced lesser trochanters may not be necessary for most elderly patients, though individual assessment remains important for patients with higher functional demands based on the patient's activity needs and physical condition.

Key words: intertrochanteric fracture, lesser trochanter separation, intramedullary nail, internal fixation, hip joint function

CLC Number:

Peng Guofei, Zhai Yifa, Lu Shuang, Jiang Kundou, Zhang Bin, Zhang Yi, She Rongfeng. Impact of lesser trochanter displacement on hip function following minimally invasive intramedullary nailing for geriatric intertrochanteric fractures[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(27): 7160-7166.

Figures/Tables 7

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