Strategies for Pertrochanteric Fracture Reduction and Intramedullary Nail Placement: Technical Tips and Tricks

Anteromedial Cortical Support in Reduction of Trochanteric Hip Fractures

“…For the definition of AMCS, we refer primarily to the original publication 9 , while also considering subsequent refinements 17,21,22 (Fig. 2).…”

“…In certain situations, the AMCS type may be easily misidentified 9,17,21,22 . Several commonly mistaken examples are illustrated in Figure 3, including the following.…”

“…The first reason is that, due to the resolution limitations of intraoperative fluoroscopy combined with the observer’s interpretation errors, some slightly negative MCS might be mistakenly classified into the “neutral MCS” group. This misclassification could potentially degrade the clinical outcomes of the neutral MCS group 9,17 . The second reason is that, due to secondary interfragmentary movement, an immediate postoperative neutral reduction does not ensure that the final bone healing will maintain a neutral reduction.…”

“…Originating in Asia, it has been widely adopted and researched within this region 14-16 . However, on a global scale, there exists some ambiguity with regard to the precise definition and application of the AMCS types, such as the misidentification of negative reduction as neutral reduction 17 . Moreover, increasing evidence has raised uncertainty with regard to the effectiveness of neutral medial cortical support (MCS), an aspect that has been previously overlooked 18-20 .…”