Key Takeaways & Executive Findings
- •• Lesser trochanter displacement <1 cm was associated with faster early functional recovery (shorter time to straight leg raise and ambulation) and higher Harris scores up to 6 months postoperatively. • No significant differences in fracture healing time or long-term (≥9 months) hip function were observed between displacement groups. • Routine fixation of the lesser trochanter is not recommended for elderly patients, but individualized fixation may benefit those with high early functional demands. • The study supports minimizing surgical trauma by avoiding unnecessary reduction, aligning with enhanced recovery after surgery principles.
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 intertrochanteric fractures and lesser trochanter separation who underwent intramedullary nailing fixation and received effective follow-up at 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) and group B (displacement <1 cm, n=23). Postoperative functional recovery indicators were compared, 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 postoperatively, and excellent rate of Harris score at final follow-up. RESULTS AND CONCLUSION: (1) No significant differences in preoperative general data between the two groups (P > 0.05). (2) Group A had significantly longer time to first straight leg raise (18.44±3.99 days vs. 15.91±3.64 days, P < 0.05) and time to first ambulation (7.83±1.92 days vs. 6.70±1.80 days, P < 0.05) compared to group B. However, fracture healing time showed no significant difference (P > 0.05). (3) Harris scores in group B were significantly higher than group A at 1, 2, 3, and 6 months postoperatively (P < 0.05), but no significant differences at 9 and 12 months (P > 0.05). (4) At final follow-up, excellent rate of Harris score (≥90) was 74% in group A and 87% in group B, with no significant difference (P > 0.05). (5) These findings indicate that elderly patients with different lesser trochanter displacement distances have different functional recovery within 6 months postoperatively, but after 6 months, the displaced lesser trochanter does not affect hip function. Therefore, routine reduction and fixation of the lesser trochanter is not recommended for elderly intertrochanteric fracture patients. However, for patients with high early functional demands, reduction and fixation may be considered after individual assessment of activity needs and physical condition.
1. Introduction
Surgical treatment is often the preferred option for most hip fracture patients [1-5], as conservative treatment is associated with higher rates of complications, mortality, and disability [6-8]. For stable intertrochanteric fractures, either extramedullary or intramedullary fixation is acceptable [9-10]. For unstable intertrochanteric fractures, reverse oblique fractures, or subtrochanteric fractures, intramedullary fixation is preferred [11], as it effectively avoids complications and enables rapid recovery. However, when geriatric intertrochanteric fractures involve the lesser trochanter, particularly with separation, there remain unresolved issues, and whether to fix the lesser trochanter is still debated.
Some scholars advocate fixation of the lesser trochanter to benefit hip function recovery and stability [12]. However, reduction of the lesser trochanter is technically demanding and often requires extensive dissection, which may damage surrounding soft tissues and blood supply, potentially hindering patient recovery and contradicting the goal of rapid rehabilitation. Therefore, some argue that if the internal fixation is sufficiently stable, correction of lesser trochanter displacement is unnecessary. This study retrospectively analyzed 46 elderly patients with intertrochanteric fractures and lesser trochanter separation who underwent intramedullary nailing at the Department of Emergency Surgery, Guizhou Provincial People's Hospital from August 2020 to December 2023, to provide clinical data on the impact of lesser trochanter displacement on postoperative function.
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Peng Guofei, Zhai Yifa, Lu Shuang, Jiang Kundou, Zhang Bin, Zhang Yi, She Rongfeng (2026). Impact of lesser trochanter displacement on hip function following minimally invasive intramedullary nailing for geriatric intertrochanteric fractures. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21645
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Frequently Asked Questions
What is the clinical significance of lesser trochanter displacement in geriatric intertrochanteric fractures?
Lesser trochanter displacement indicates an unstable fracture pattern. This study found that displacement <1 cm is associated with faster early functional recovery, but long-term hip function is not significantly affected, suggesting that routine fixation may not be necessary.
Should the lesser trochanter be fixed in elderly patients with intertrochanteric fractures?
Based on this study, routine fixation is not recommended for elderly patients. However, for those with high early functional demands, individualized reduction and fixation may be considered after careful assessment.
How does lesser trochanter displacement affect postoperative recovery?
Patients with displacement <1 cm had significantly shorter time to first straight leg raise and ambulation, and higher Harris scores up to 6 months postoperatively, but no differences were observed after 6 months.
What are the advantages of avoiding lesser trochanter fixation?
Avoiding fixation reduces surgical trauma, preserves soft tissue and blood supply, and aligns with enhanced recovery after surgery principles, potentially leading to faster rehabilitation.
What are the limitations of this study?
The study did not include fracture fragment size or displacement direction, which may influence outcomes. Additionally, the sample size was relatively small, and the retrospective design may introduce bias.
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