Role of additional lateral wall buttressing in the management of unstable trochanteric fractures treated by internal fixation: a prospective observational study

Background: Unstable trochanteric fractures have a high risk of biomechanical failure, particularly when the lateral femoral wall is compromised. This study evaluated the clinical and radiological outcomes of cephalomedullary fixation augmented with an additional lateral buttress plate. Methods: This prospective, single-centre observational study included 50 patients aged 25–80 years with unstable trochanteric fractures (AO/OTA 31A2.2, 31A2.3 and 31A3) treated between March 2022 and July 2024. Fractures were stabilised with a cephalomedullary nail supplemented by a lateral buttress plate selected according to availability. Patients were evaluated at 6 weeks, 3 months and 6 months. Functional outcomes were assessed using the Harris Hip Score (HHS), while radiological evaluation included union, alignment and implant-related complications. Results: Mean age was 59.36±11.61 years, and falls accounted for 76% of injuries. Mean operative time was 107.7±14.4 minutes and blood loss was 228.6±14.3 ml. Mean HHS improved from 46.38±4.17 at 6 weeks to 82.58±6.81 at 6 months. At final follow-up, 90% achieved good-to-excellent outcomes. All fractures united, with a mean union time of 13.3 weeks. Superficial infection occurred in 4% and implant impingement in 6%. No varus malunion, Z-effect, screw cut-out, implant breakage or non-union occurred. Conclusion: Lateral buttress plate augmentation with cephalomedullary fixation provided favourable functional and radiological outcomes with a low complication rate in unstable trochanteric fractures.