Implant options for the treatment of unstable femoral intertrochanteric fractures

Abstract

Femoral intertrochanteric fracture, accounting for about 50% of hip fractures, is one of the common fracturein elderly patients and arguably the most important public health problem faced by orthopedic surgeons. Early surgical interventions, which are of benefit to early restoring limb function and reducing post-operative complications, have gradually become the optimal solution to treating femoral intertrochanteric fractures. Intramedullary andextramedullary fixation methods are two of the widely used techniques for surgical interventions. The dynamic hip screw (DHS) had been considered the standard fixation devicefor treating stable femoral intertrochanteric fractures. For unstable femoral intertrochanteric fractures, early reports suggested somesubstantial advantages in association with intramedullary devices, including a minimally invasive surgical technique, shortened operating times, improved biomechanics, greater stability of fixation, earlier patient mobilization and shorter lengths of stay. In the last 10 years we have also seen the introduction, increasing acceptance and use of the proximal femoral locking compression plate (PFLCP) in preference to the DHS, for the treatment of unstable femoral intertrochanteric fractures. It could provide angular stable plate and optimal fixation of highly unstable fractures associated with greater shearing and pull-out forces. However, the optimal fixation method of treating unstable femoral intertrochanteric fractures remains controversial. For the unstable femoral intertrochanteric fracture, intramedullary fixation has superiority in the biomechanics, because it more closes to the center of gravity and its force arm is shorter. Intramedullary nail can resistthe conductive stress along with calcar femoral well and can prevent the femoral shaft ingression. As the intramedullary nail provides more stability and allows for earlier weight bearing than the PFLCP when used for the treatment of unstable intertrochanteric fractures of the femur. While PFLCP are associated with a high complication rate, so intramedullary nailing was more beneficial for patients with an unstable femoral intertrochanteric fracture.