Use of minimally invasive techniques to optimize the reduction of extracapsular proximal femur fractures: Indications and outcomes. Our treatment algorithm.

Abstract

Introduction: Pertrochanteric fractures are among the most common conditions in trauma surgery, and the treatment of choice is closed reduction and internal fixation. The main predictor of a good functional outcome is the quality of reduction; therefore, open reduction is often required. The primary objective of this study was to analyse the outcomes regarding reduction quality in pertrochanteric fractures requiring open reduction and to describe the techniques used through our treatment algorithm.

Materials and methods: A retrospective descriptive study was conducted including all patients with pertrochanteric fractures treated with intramedullary nailing who required open reduction between 2022 and 2024 at a tertiary care hospital. Demographic variables, fracture characteristics, surgical techniques, functional outcomes, and complications were collected. Radiological reduction quality was assessed according to the Baumgaertner and Kim modified classification, which categorizes reduction into three levels.

Results: During the study period, a total of 1,034 fractures were surgically treated, of which 100 met the inclusion criteria (9.7%). Seventy-four percent of patients were women, with a mean age of 81 years. The most frequent fracture subtype was AO classification 31-A3.3. Satisfactory reduction was achieved in 75% of cases. Poor reduction was observed in 25% of patients with 31-A3.3 fractures. In 74% of patients, a Hohmann retractor and/or Verbrugge clamp were used. The overall complication rate was 13%, being more frequent in cases with poor reduction.

Conclusion: AO 31-A2 and 31-A3 pertrochanteric fractures often present difficulties in achieving adequate reduction and frequently require open reduction techniques. These manoeuvers are summarized in our treatment algorithm.