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Purpose Tointroducetheconceptoffracturereductionwithpositivemedialcorticalsupportanditsclinicaland radiologicalcorrelationingeriatricunstablepertrochantericfractures. Methods Aretrospectiveanalysisof127patients(32menand95women,withmeanage78.7years)with AO/OTA31A2.2and2.3hipfracturestreatedwithcephalomedullarynail(PFNA-ⅡorGamma-3)betweenJuly 2010andJune2013wasperformed.Theywereclassifiedintothreegroupsaccordingthegradeofmedialcortical supportinpost-operativefracturereduction(positive,neutral,ornegative).Thepositivecortexsupportwas definedthatthemedialcortexofthehead-neckfragmentisdisplacedandlocatedalittlebitsuperomediallyto themedialcortexoftheshaft.Thedemographicbaseline,postoperativeradiographicfemoralneck-shaftangle andnecklength,rehabilitationprogressandfunctionalrecoveryscoresofeachgroupwererecordedand compared. Results Therewere89cases(70%)inpositive,26inneutral,and12innegativesupport.Nostatisticaldifferences werefoundbetweenthethreegroupsamongpatientage,sexratio,pre-fracturescoreofactivityofdailyliving, walkingabilityscore,ASAphysicalriskscore,numberofmedicalcomorbidities,osteoporosisSinghindex, fracturereductionquality(Gardenalignments)andthepositionoflagscreworhelicalbladeinfemoralhead(TAD).Infollow-up,patientsinpositivemedialcorticalsupportreductiongrouphadtheleastlossinneck-shaft angleandnecklength,andgotground-walkingmuchearlierthannegativereductiongroup,withgood functionaloutcomesandlesship-thighpainpresence. ConclusionFracturereductionwithpositivemedialcorticalsupport,allowslimitedslidingofthehead-neck fragmenttocontactwiththefemurshaftandachievesecondarystability,providingagoodmechanical environmentforfracturehealing.