Augmentation of Intramedullary Nailing With a Trochanteric Buttress Plate for Unstable Intertrochanteric Femur Fractures With Lateral Wall Disruption: A Prospective Case Series

Objective: Unstable intertrochanteric femur fractures with concomitant lateral wall disruption have a higher risk of varus collapse, medialization, and fixation failure because the lateral buttress is compromised. Augmenting intramedullary nailing with a trochanteric buttress plate (TBP) is intended to restore lateral wall support and improve construct stability. Methods: In this single-center prospective case series, 50 adult patients with unstable intertrochanteric fractures associated with a broken lateral wall were treated with a proximal femoral intramedullary nail augmented with a TBP. Patients were followed at 6 w, 3 mo, 6 mo, and 12 mo. Radiological union, complications, and functional outcome using the Harris Hip Score (HHS) were assessed. Statistical analysis was descriptive. Results: The mean patient age was 59.5±6.5 y, and the male-to-female ratio was 33:17. mean operative time was 95.3±10.9 min and mean intraoperative blood loss was 160.8±5.8 ml. Radiological union was achieved at a mean of 11.1 w. Reduction quality graded as Chang score 4 was observed in 47/50 cases (94%). mean HHS at final follow-up was 95.3, with 80% excellent, 16% good, and 4% fair outcomes. One patient (2%) had a screw-related complication; no implant breakage was observed. Conclusion: Augmentation of intramedullary nailing with a TBP produced reliable union and excellent short-term functional outcomes in this cohort of unstable intertrochanteric fractures with lateral wall disruption. Comparative studies with standardized radiographic measurements are required to confirm whether TBP augmentation reduces collapse and improves gait-related outcomes versus nailing alone.