44 - Intertrochanteric Fractures

Abstract

The treatment of intertrochanteric femur fractures is almost always operative. Compression hip screws are best used in stable fracture patterns and are associated with low rates of complications when properly positioned within the center of the femoral head. Cephalomedullary nails have been the implant of choice for unstable intertrochanteric fractures and for reverse-oblique fractures. The compression hip screw has been as effective in treating stable intertrochanteric fractures as a cephalomedullary nail. Recent published studies show that the clinical outcome of using a compression hip screw with a trochanteric side plate is the same as that of a cephalomedullary nail in unstable fractures. Fracture type, cost, and the experience of the surgeon should be considered when choosing a device in treating intertrochanteric fractures. Historically, cephalomedullary nails have been associated with higher rates of revision surgery than compression hip screws, largely because of the increased risk of postoperative femur fracture. However, this complication seems to be decreasing with current nail designs, and more recent series have found no increased risk of femoral fracture in patients treated with cephalomedullary nails compared with compression hip screws.