Incomplete Intertrochanteric Fractures, Outcome of Nonoperative Treatment Protocol

Introduction:
Incomplete intertrochanteric femur (IITF) fractures are a relatively newer diagnosis that have become more prevalent with the increased usage and availability of MRI. IITF is defined as an Intertrochanteric fracture which doesn`t involve the medial cortex. At Present, there is no consensus on the ideal treatment of these injuries. In our level 1 trauma centre we have a strict protocol for the diagnosis and treatment of patients with occult hip fractures. We treat all incomplete intertrochanteric fracture nonoperatively with weight bearing as tolerated. We believe that the theoretical risk of these fracture to progress into a complete Intertrochanteric (IT) fracture is very little. This theoretical risk was reported in the paucity literature that is found on this issue, studies have recommended operative fixation for GT fractures with IT extension >50% into the IT region and others treated all these fractures operatively. The aim of this study was to investigate the outcome of our nonoperative treatment protocol for incomplete IT fracture over the last ten years.

Patients and Methods:
Hospital Data base was revised for IT fractures that were diagnosed with MRI between the years 2011-2021. Patients that were either diagnosed with IT fracture line which doesn’t involve the medial cortex or a femoral greater trochanter fracture with an extension of the fracture line to the IT area but does not cross the medial cortex, were included in the cohort. Our institutional protocol for these patients includes nonoperatively treatment with weightbearing as tolerated. Close follow up with radiographic assessment in weeks 2,6, and 3 months was recommended.

Results:
We had 9 patients in our cohort which met the inclusion criteria. Seven males and two females. Average of age was 79.8 years (range 66-90), hospitalization duration 4.4 days (range 1-12) and follow up 7.1 months (range 3-24) . Records of functional state before the injury were 5 patients independent, 2 used canes as a walking aid and 2 used wheelchair for mobilization. We didn`t record any patient which had extension of the fracture in the follow up period. Two patients did not appear to follow up appointments after discharge, they were contacted by phone calls and were questioned if they had suffered from a refracture or have been operated on the same hip.

Discussion/Conclusion:
The outcome of our nonoperative treatment protocol for incomplete IITF emphasises that these fractures could be safely treated non operatively.