Journal of Musculoskeletal Trauma

Original Article

Percutaneous anterior leverage technique for anteromedial cortical support in intertrochanteric femur fractures: a computed tomography-based validation study: Whee Sung Son, Bum Jin Shim, Oog-jin Shon; Received September 24, 2025 Accepted December 10, 2025 Published online March 27, 2026; DOI: https://doi.org/10.12671/jmt.2025.00311 [Epub ahead of print]

Abstract PDF: Background
Anteromedial cortical support (AMCS) enhances stability in intertrochanteric femur fractures. However, reproducible, validated methods of achieving AMCS have not previously been reported. This study introduces a percutaneous anterior leverage technique and validates its AMCS effects using computed tomography (CT).
Methods
We retrospectively reviewed patients treated by a single surgeon between March 2022 and December 2024. The inclusion criteria were an AO/OTA classification of A1–A3, application of the percutaneous anterior leverage technique, available pre- and postoperative CT, and ≥6 months follow-up. Outcomes included CT-based AMCS (anterior on axial and medial on coronal images, classified as positive, neutral, or negative), time to union, union rate, changes in neck-shaft angle, and treatment failure (varus collapse, blade cut-through, or nonunion without the former two). The risk factors for failure were analyzed.
Results
Of 273 patients reviewed, 53 met the inclusion criteria. Follow-up was at least 6 months in all cases. Positive anterior support was achieved in 37 patients (69.8%) and positive medial support in 42 (79.25%). No patient demonstrated negative anterior support; one (1.9%) had negative medial support. Cortical support improved significantly after surgery. CT images demonstrated significant postoperative improvements (anterior P=0.026; medial P<0.001). Bone union was achieved in 50 patients (94.34%) at a mean of 3.93±1.48 months. The mean change in the neck-shaft angle at last follow-up was 1.75°±2.34° varus. Three patients (5.66%) experienced treatment failure. Anteromedial cortical breakage during follow-up differed between failure and non-failure groups (P=0.002), but regression identified no independent predictors. No technique-related complications were observed.
Conclusions
Our percutaneous anterior leverage technique produced favorable CT-confirmed AMCS and high union with low failure, supporting its safety and effectiveness in intertrochanteric femur fractures. Level of evidence: IV.

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Technical Note

Rim plate-assisted intramedullary nail and plate combination technique for complex tibial plateau-to-diaphysis fractures: a technical note and case series: Whee Sung Son; J Musculoskelet Trauma 2026;39(1):62-71. Published online December 4, 2025; DOI: https://doi.org/10.12671/jmt.2025.00290

Abstract PDF: Complex tibial plateau-to-diaphysis fractures present a significant surgical challenge due to their intricate fracture patterns and frequent association with severe soft tissue damage and concomitant injuries. This technical note introduces a novel fixation strategy: the rim plate-assisted intramedullary nail-plate combination (NPC) technique. In this approach, a rim plate simplifies the conventional NPC procedure by unifying the tibial plateau fracture into a single structural segment. This modification eliminates the need to address the articular and diaphyseal components simultaneously while enhancing articular stability. Furthermore, the technique preserves soft tissue integrity and promotes early rehabilitation. Clinical case examples demonstrate its successful application in managing complex tibial plateau-to-diaphysis injuries. Level of evidence: V.

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