Reliability of lateral femoral wall thickness for detecting the potential for treatment failure and implant choice in patients with trochanteric hip fractures: a prospective cohort study

Background: Trochanteric hip fractures represent one of the most challenging injuries in orthopaedic practice. Dynamic hip screw (DHS) remains the gold standard in management of these fractures. Lateral femoral wall thickness (LWT) is an evolving parameter for detecting the potential for lateral wall fracture. The aim of this study was to determine the mean and cutoff levels for LWT that predict lateral wall fracture and its various implications. Methods: This prospective cohort study included 42 patients with trochanteric hip fractures treated with DHS. LWT was assessed in all patients preoperatively. Patients were divided into two groups according to the postoperative integrity of the lateral femoral wall; in group A the patients sustained a lateral femoral wall fracture, and in group B the lateral femoral wall remained intact. All patients were regularly followed for 12 mo. Results: At 12 mo, 12% of patients suffered postoperative lateral wall fracture, while in 88% the lateral femoral wall remained intact. The mean LWT in group A was 18.04 mm compared to 26.22 mm in group B. Revision surgery was 40% in group A and 5% in group B. The cutoff point of LWT below which there is a high chance of postoperative lateral wall fracture when fixed with DHS was 19.6 mm. Conclusions: Preoperative measurement of LWT in elderly patients with trochanteric hip fractures was decisive. The cutoff point for postoperative lateral wall fracture according to this study was 19.6 mm; hence, intramedullary fixation should be considered in this situation. Level of Evidence: Level II.