Enhancing Reduction Quality and Union Time in Reverse Oblique Intertrochanteric Femur Fractures: A Comparative Analysis of Cephalomedullary nail with Side Plate Augmentation

Background: This study aimed to evaluate and compare the efficacy of the cephalomedullary nail (CMN) with side plate, CMN with cerclage wire, and CMN alone in the treatment of reverse oblique intertrochanteric femur fractures with respect to reduction quality, loss of reduction, union time, and complications. Methods: This retrospective study evaluated patients aged 18 years or older with reverse oblique intertrochanteric fractures (OTA/AO 31A3.1 and 31A3.3) treated with CMN. Exclusion criteria included pathological fractures, open fractures, previous hip surgery, segmental fractures, and follow-up less than 2 years. Outcome measures included reduction quality (modified Baumgaertner criteria), union time, loss of reduction (varus collapse), and complications. These results were compared among the three treatment groups. Results: 54 patients were included. 12 in the side plate group, 15 in the cerclage wire group, and 27 in the CMN group. No significant differences in demographic parameters were observed between the groups. The plate group demonstrated superior reduction quality and shorter union time compared to the cerclage and CMN groups (p < 0.01). A higher incidence of reduction loss was observed in the CMN group compared to the cerclage and plate groups. Reduction quality was significantly associated with a reduced incidence of reduction loss and a shorter union time (p < 0.05). Conclusions: In the treatment of reverse oblique intertrochanteric femur fractures, the incorporation of a side plate alongside CMN appears to offer superior reduction quality, reduced incidence of varus collapse, and shorter union time compared to cerclage wire or CMN alone. This approach may represent a valuable alternative for treating surgeons facing these challenging fracture patterns.