Reverse obliquity and transverse fractures of the trochanteric region of the femur; a review of 101 cases

Injury. 2005 Jul;36(7):851-7. doi: 10.1016/j.injury.2005.02.004. Epub 2005 Apr 2.


Background: Reverse obliquity and transverse fractures of the proximal femur represent a distinct fracture pattern in which the mechanical forces displace the femur medially thus increasing the risk of fixation failure. There is a paucity of published literature in this area of trauma. This study constitutes the largest series of such fractures.

Methods: Using a retrospective analysis of prospectively collected data from a single institution, 101 reverse obliquity and transverse fracture patterns were identified from 3336 consecutive hip fractures. All surviving patients were followed up for 1 year.

Results: Of 100 patients treated operatively, 59 were treated with 135 degrees sliding hip screws (SHS), 19 with a Medoff plates modification of the SHS, three with a sliding hip screw and trochanteric stabilising plate and 19 with intramedullary sliding hip screw devices. Nine fracture fixation-healing complications occurred, with cut-out being the commonest complication (seven cases). Cut-out of the implant was associated with femoral medialisation and a larger tip to apex distance.

Conclusion: This fracture pattern is a challenge for the orthopaedic surgeon with a high risk of fracture healing complications. The 135 degrees SHS and the intramedullary devices had similar failure rates.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Plates
  • Bone Screws
  • Female
  • Fracture Fixation, Intramedullary / methods*
  • Hip Fractures / complications
  • Hip Fractures / diagnostic imaging
  • Hip Fractures / surgery*
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Retrospective Studies
  • Treatment Failure