Two cases of reciprocal migration of two screws (Z-effect) required exchange of the femoral neck screw to a shorter one in the PFN group. The mean union time was longer in the A3.3 group (5.98 months, range 3-17 months) compared with that in the A3.1 or A3.2 group (4.65 months, range 3-9 months) (p = 0.048). They occurred in the A3.3 type fracture, which were fixed with the PFN. The complications were four cases of fixation failure and one case of femoral shaft fracture after fall. Twenty-five fractures were fixed with proximal femoral nail (PFN), and 21 fractures were fixed with intertrochanteric subtrochanteric nail.Īmong 40 patients, followed up for more than 6 months, 22 31-A3.3 fractures (84.6%) out of 26 and all 14 A3.1 or A3.2 fractures were healed after the first operation. We retrospectively reviewed the clinical results of 46 cases of reverse obliquity or transverse intertrochanteric fracture treated with intramedullary hip nails. Even though some clinical reports regarding intramedullary hip nailing for reverse obliquity intertrochanteric fracture show favorable results, there has been no clinical report of intramedullary hip nailing regarding the clinical significance of the lesser trochanteric fragment which differentiates Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A3.3 from A3.1 and A3.2. Reverse obliquity intertrochanteric fractures have been recognized as having unique anatomic and mechanical characteristics.
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