Intraoperative Guidewire Loosening, Intraoperative and Postoperative Treatment Outcomes in Traditional versus Modified Medullary Fixation Techniques in Patients with Intertrochanteric Femoral Fractures

Background: The authors’ pilot study found that when the femoral guidewire passes through to the acetabulum during an intramedullary fixation, it led to less guidewire loosening and shorter operative times. Objective: To compare the incidence of femoral guidewire loosening once passed through to the acetabulum and other treatment outcomes between traditional and modified medullary fixation techniques in patients with intertrochanteric fractures. Materials and Methods: Therapeutic research with retrospective observational cohort data collection was conducted on patients with intertrochanteric fractures who had surgery with cephalomedullary fixation at Nong Bua Lamphu Hospital. Two study groups were divided by surgical technique. The traditional technique inserted a femoral guidewire within 5 mm of the subchondral bone of the femoral neck. The modified technique inserted a femoral guidewire within 5 mm of the surface of the acetabular joint, and the femoral guidewire was used as a counteracting force while the screws or blade were removed. Patients were followed up during their postoperative inpatient stay and at one-, three-, and six-months postoperatively. The comparison focused on perioperative femoral guidewire loosening and other treatment outcomes between the two groups during the follow-up period. Results: Of the 109 patients, which included 55 patients with modified techniques, there were no differences in patient characteristics, except for the mechanism of femoral fracture, preoperative status, and type of material used for fixation. After adjusting for these factors, the occurrence of femoral guide wire loosening was lower in the modified technique group (risk difference –10.15, 95% CI –18.64 to –1.67, p=0.019) with less blood loss during both intra- and post-operation. Moreover, the modified technique indicated a lower, limited range of motion for the hip compared to the traditional group. Conclusion: The authors recommend using a modified technique for cephalomedullary fixation in patients with intertrochanteric fractures of the femur because it has a lower chance of the femoral guidewire coming loose during surgery, less bleeding, and better hip movement after surgery.