Primary Bone Grafting in Comminuted Intertrochanteric Fractures Treated with Cephalomedullary Nails: Biological Rationale, Current Evidence, and Clinical Decision-Making

Objective To provide a narrative review of the biological rationale, current evidence, and clinical decision-making considerations surrounding primary bone grafting in comminuted intertrochanteric fractures treated with cephalomedullary nails. Methods A focused narrative review was performed using PubMed/MEDLINE, Scopus, and Google Scholar. Relevant English-language studies and reviews addressing intertrochanteric fracture fixation, fracture healing biology, bone grafting, non:union:, augmentation strategies, and cephalomedullary nail complications were reviewed and synthesized. Results The available literature strongly supports the importance of mechanical optimization, including acceptable reduction, restoration of medial support, appropriate implant placement, and construct stability. In contrast, direct comparative evidence evaluating cephalomedullary nail fixation with and without primary bone grafting in acute comminuted intertrochanteric fractures is scarce. Evidence supporting graft use is therefore largely indirect and derives from fracture healing biology, non:union: treatment, revision surgery, and the management of bone defects. These data suggest that while grafts may enhance osteogenesis, osteoinduction, and osteoconduction, routine grafting for all unstable fractures is not currently supported. Conclusion Primary bone grafting should not be considered a routine component of fixation for all comminuted intertrochanteric fractures. Mechanical stability remains the principal determinant of :union:. Primary grafting may be considered selectively in the presence of major residual defects, persistent biological disadvantage, or situations in which fracture biology appears compromised despite adequate fixation. The current evidence supports a selective, individualized approach rather than universal graft augmentation.

کلیدواژه ها:

Intertrochanteric fracture ، cephalomedullary nail ، bone grafting ، fracture healing ، non:union: ، biological augmentation