To fix or not to fix? Evaluating lesser trochanter fixation in unstable intertrochanteric fractures: A randomized controlled trial

Abstract

Purpose: The necessity of lesser trochanter (LT) fixation in unstable intertrochanteric fractures remains uncertain, particularly in cases with LT displacement between 5 and 10 mm. This study aimed to determine whether cerclage wire augmentation improves postoperative hip flexor strength, functional recovery, and fracture healing compared to standard cephalomedullary nail fixation alone. Methods: A double-blinded, randomized controlled trial was conducted at a tertiary referral center, enrolling patients aged ≥60 years with unstable intertrochanteric fractures and LT displacement of 5–10 mm. Patients were randomly assigned to cephalomedullary nail alone (Group A) or cephalomedullary nail with cerclage wire fixation (Group B). The primary outcome was maximal isometric hip flexor strength at 1.5, 3, 6, and 12 months. Secondary outcomes included Barthel’s Index (BI), Harris Hip Score (HHS), Radiographic Union Score for Hip (RUSH), operative time, hospital stay, and complications. Statistical analyses included independent t-tests, chi-square tests, and linear mixed models. Results: A total of 46 patients (23 per group) were analyzed. No significant differences were observed in hip flexor strength or functional outcomes. However, the cerclage wire group demonstrated significantly higher RUSH scores at 3, 6, and 12 months (p <.05), indicating enhanced fracture healing. Operative time was significantly longer in the cerclage wire group (p =.005). Two cases of cerclage wire breakage occurred, neither requiring reoperation. Conclusion: LT fixation for 5–10 mm displacement did not improve hip flexor strength or functional recovery but significantly enhanced fracture healing. Given the increased operative time, LT fixation should be selectively considered in cases where accelerated fracture healing is a priority. Further research is warranted to assess long-term clinical outcomes.