Hip Screw Fixation Research Articles

Smart-Draping-A Validated Novice Technique to Prevent Drapes Peeling off During Hip Fracture Fixation Surgery: A Prospective Randomized Controlled Study

The contamination of the surgical field can be a potential risk of infection that can be devastating to patients undergoing hip fracture fixation surgery. Drapes peeling off during such operation is a recognized challenge that can lead to such a contamination. We describe and validate a simple technique to prevent drapes peeling off the operative field during hip fracture fixation surgery using the smart-draping technique. The smart-draping entails applying a sterile disposable single large adhesive op-sheet to the inferior aspect of the thigh, just under the proposed surgical incision, followed by applying the usual plastic vertical isolation drape. Fourteen neck-of-femur fracture patients undergoing dynamic hip screw (DHS) fixation were recruited and randomized into a study and control groups to measure fluid leakage, as an indirect measurement of the vertical drapes peeling off the surgical site. Incontinence pads were placed on the floor to collect all leaked fluid in all patients. The average weight of the fluid collected in the study groups was 11.4 gm (SD ± 12.1) while that of the control group was 354.3 gm (SD ± 175). There was a statistical significant difference between the two methods favoring the smart-draping method over the control one. (P<0.001) We conclude that smart-draping technique will make it harder for the drapes to peel off thus, avoiding the potential contamination of the surgical field and ultimately avoiding potential infection of the surgical site in hip fracture fixation surgery.

Uncemented hip arthroplasty for failed internal fixation of peritrochanteric fracture

Objective To observe the outcome of uncemented hip arthroplasty for failed internal fixation of intertrochanteric fracture. Methods Seventeen patients admitted from Februaty 2010 to January 2014 were reviewed retrospectively in this study. The patients aged 67.2 years(range, 41-80 years) composed 6 males and 11 females. There were 15 patients with intertrochanteric fracture and 2 intertrochanteric and subtrochanteric fracture. The primary internal fixation method was dynamic hip screw (DHS) fixation in 2 patients, proximal femoral nail anti-rotation(PFNA) fixation in 12 patients and intramedullary nailing in 3 patients. Arthroplasty with a prosthetic hip was performed for 15 patients and with a prosthetic femoral head was done for 2 patients 3-48 months after the internal fixation. Harris score was used for evaluation of the results of hip arthroplasty. Preoperative Harris score was (32.6±6.8)points. Results All the patients were followed up for 6 to 48 months. One patient with intraoperative femoral fracture experienced early subsidence and dislocation of femoral stem following allogeneic bone plate and titanium cable fixation and had further revision surgery. One patient had secondary subsidence of the femoral stem without pain and limitation of motion. One patient had primary infection recurrence after arthroplasty, but the infection remained uncured even after a series of treatments like repeated debridements, sustained vacuum drainage, prosthesis removal, debridement and temporary spacer implantation. Sixteen patients showed postoperative pain relief and good hip function recovery characterized by the ability to care for themselves and no prosthetic loosening. Harris hip score significantly improved to (79.2±15.9)points at the final follow-up (P<0.01). Conclusions Uncemented hip arthroplasty is an effective method for the failed internal fixation of peritrochanteric fracture. The procedure achieves satisfactory function recovery, early weight-bearing exercise and early recovery of self-care ability, and avoids the complications of bone cement use. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure

A Convenient Way to do Valgus Osteotomy for Neglected Fracture Neck of Femur

Neglected fracture of neck of femur in young adults is a major problem in developing countries. Existing treatment options varies from osteotomy to various graft techniques (muscle pedicle, vascularized and nonvascularized fibula etc.). There is paucity of literature regarding the use of double angle barrel plate and hip screw in such cases. We conducted a prospective longitudinal observational study with displaced, neglected fracture neck of femur in young adults and compared the results with literature. The aim of this study was to determine feasibility and effectiveness of 120° double angle barrel plate and hip screw fixation in neglected fracture neck of femur. Effectiveness of fixed 30 degree closed wedge osteotomy in neglected fracture neck of femur. Thirty cases of neglected (more than three weeks) femoral neck fracture (Pauwel II and III) of age 20-60 years were included in the study conducted at Postgraduate Institute Of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India in year 2004-06. Average age of the patient was 35.4 years (range, 22yrs-55yrs). In all cases internal fixation was done by 120° double angle barrel plate and hip Screw. At the end of follow-up, results were evaluated according to Askin Bryan Criteria and Harris-hip score. Union was achieved in 28 of 30 patients. Two patients that went into nonunion were later treated with hemireplacement arthroplasty. According to Askin Bryan Criteria at the end of study, 35% patients had excellent results, 50% patients had good results. Minimum follow-up in our study was 12 months and maximum was five years. This study validates the use of double angled screw plate configuration for successful outcome in patients with neglected fracture neck of femur. Valgus osteotomy is also technically easy operation in hands of average trauma surgeon with the use of a fixed angle plate and hip screw.

Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures.

Intertrochanteric hip fractures are a major source of morbidity and financial burden, accounting for 7% of osteoporotic fractures and costing nearly $6 billion annually in the United States. Traditionally, "stable" fracture patterns have been treated with an extramedullary sliding hip screw whereas "unstable" patterns have been treated with the more expensive intramedullary nail. The purpose of this study was to identify parameters to guide cost-effective implant choices with use of decision-analysis techniques to model these common clinical scenarios. An expected-value decision-analysis model was constructed to estimate the total costs and health utility based on the choice of a sliding hip screw or an intramedullary nail for fixation of an intertrochanteric hip fracture. Values for critical parameters, such as fixation failure rate, were derived from the literature. Three scenarios were evaluated: (1) a clearly stable fracture (AO type 31-A1), (2) a clearly unstable fracture (A3), or (3) a fracture with questionable stability (A2). Sensitivity analysis was performed to test the validity of the model. The fixation failure rate and implant cost were the most important factors in determining implant choice. When the incremental cost for the intramedullary nail was set at the median value ($1200), intramedullary nailing had an incremental cost-effectiveness ratio of $50,000/quality-adjusted life year when the incremental failure rate of sliding hip screws was 1.9%. When the incremental failure rate of sliding hip screws was >5.0%, intramedullary nails dominated with lower cost and better health outcomes. The sliding hip screw was always more cost-effective for A1 fractures, and the intramedullary nail always dominated for A3 fractures. As for A2 fractures, the sliding hip screw was cost-effective in 70% of the cases, although this was highly sensitive to the failure rate. Sliding hip screw fixation is likely more cost-effective for stable intertrochanteric fractures (A1) or those with questionable stability (A2), whereas intramedullary nail fixation is more cost-effective for reverse obliquity fractures (A3). These conclusions are highly sensitive to the fixation failure rate, which was the major influence on the model results.

Comparison on clinical effects of Trigen intramedullary nails versus dynamic hip screws in treatment of intertrochanteric fractures combined with ipsilateral femoral neck fractures

Objective To compare the clinical effects of Trigen intramedullary nailing and dynamic hip screw (DHS) fixation in treatment of intertrochanteric fractures combined with ipsilateral femoral neck fractures.Methods The study enrolled 41 patients followed up from 47 patients with intertrochanteric fractures combined with ipsilateral transcervical fractures treated with DHS or Trigen nails from June 2005 to April 2011.Period of follow-up was 20-90 months (mean,45.6 months).There were 22 males and 19 females aged at 24-56 years (mean,40.29 years).Injury was caused by traffic accidents in 32 patients and fall from height in 9.Associated injuries included craniocerebral trauma in 2 patients,distal radioulnar fracture in 1,and ipsilateral tibiofibular fracture in 1.According to the improved Evans classification of intertrochanteric fracture,there were 12 patients with type Ⅲ fractures,18 with type Ⅳ,and 11 patients with type V.According to the sites of injury,femoral neck fracture were classified to basal type in 24 patients,transcervical type in 13,and sub-capital type in 4.The patients were randomly divided into DHS group n =20) and Trigen intramedullary nail group (n =21).Two groups were compared in aspects of postoperative complications,operation time,intraoperative blood loss,postoperative hospital stay,postoperative weight-bearing time,and fracture healing time.Besides,the hip joint function was assessed using Harris score at 6 months postoperatively.Results Apart from postoperative complications,operation time,postoperative hospital stay,fracture healing time,and Harris hip score,intraoperative blood loss [(370.7 ± 73.4) ml] and postoperative weight-bearing time [(20.4 ± 3.1) days] in DHS group revealed statistical difference compared with Trigen intramedullary nail group[(173.0 ± 55.8)ml,(14.9 ± 1.5) days,P ＜ 0.05].Conclusions Trigen intramedullary nailing system is a suitable internal fixator for intertrochanteric fractures combined with ipsilateral femoral neck fractures.DHS internal fixation can be considered when Trigen intramedullary nailing is difficult. Key words: Hip fractures; Fracture fixation, internal; Treatment outcome

Ipsilateral Proximal Femur and Shaft Fractures Treated With Hip Screws and a Reamed Retrograde Intramedullary Nail

Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results. We investigated the use of hip screws and a reamed retrograde intramedullary (IM) nail for the treatment of this combined fracture pattern in terms of postoperative alignment (malunion), nonunion, and complications. Between May 2002 and October 2011, a total of 95 proximal femoral fractures with associated shaft fractures were treated at three participating Level 1 trauma centers; all were treated with hip screw fixation (cannulated screws or sliding hip screws) and retrograde reamed IM nails. The medical records of these patients were reviewed retrospectively for alignment, malunion, nonunion, and complications. Followup was available on 92 of 95 (97%) of the patients treated with hip screws and a retrograde nail. Forty were treated with a sliding hip screw, and 52 were treated with cannulated screws. There were five proximal malunions in this series (5%). The union rate was 98% (90 of 92) for the femoral neck fractures and 91.3% (84 of 92) for the femoral shaft fractures after the initial surgery. There were two nonunions of comminuted femoral neck fractures after cannulated screw fixation. There was no difference in femoral neck union or alignment when comparing cannulated screws to a sliding hip screw. Four open comminuted femoral shaft fractures went on to nonunion and required secondary surgery to obtain union, and one patient developed symptomatic avascular necrosis. The treatment of ipsilateral proximal femoral neck and shaft fractures with hip screw fixation and a reamed retrograde nail demonstrated a high likelihood of union for the femoral neck fractures and a low risk of malunion. Comminution and initial displacement of the proximal femoral fracture may still lead to a small incidence of malunion or nonunion, and open comminuted femoral shaft fractures still may progress to nonunion despite appropriate surgical management. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Retraction: “Outcome of Short Proximal Femoral Nail Antirotation and Dynamic Hip Screw for Fixation of Unstable Trochanteric Fractures. A Randomised Prospective Comparative Trial” [Hip Int 2011; 21(05): 531–6

Retraction: “Outcome of Short Proximal Femoral Nail Antirotation and Dynamic Hip Screw for Fixation of Unstable Trochanteric Fractures. A Randomised Prospective Comparative Trial” [Hip Int 2011; 21(05): 531–6

Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures in elderlv patients

Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage. Key words: Arthroplasty, replacement, hip; Hip fractures; Treatment failure

Effect of hip joint replacement on the femoral intertrochanteric fracture with failed internal fixation

Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement. Key words: Femoral fractures; Fracture fixation, internal; Arthroplasty, replacement, hip

Conventional Muscle-Reflection Approach versus Mini-Incision Muscle-Splitting Approach in Dynamic Hip Screw Fixation

To compare the short-term results of conventional versus mini-incision approaches to dynamic hip screw (DHS) fixation. 41 geriatric patients with either basal femoral neck or intertrochanteric fractures (Kyle types I to III) who underwent closed reduction and DHS fixation by a single surgeon were retrospectively reviewed. From January 2001 to June 2005, 6 men and 19 women aged 60 to 94 (median, 83) years underwent DHS fixation through a conventional muscle-reflection approach with a skin incision of 10 cm or more. From July 2005 to March 2006, 9 men and 7 women aged 67 to 95 (median, 81) years underwent DHS fixation through a mini-incision (4 cm) approach at the lower border of the lesser trochanter. Operating time, drain output and duration of drain placement, decrease in haemoglobin level and receipt of blood transfusions, deterioration in ambulation status, analgesic intake, duration of hospital stay, and bone healing time for the 2 groups were compared. An independent observer retrospectively assessed the fracture pattern, reduction quality, and bone healing time. Compared to patients in the conventional group, those in the mini-incision group had shorter operating times (50 vs 43 minutes, p=0.02), a higher proportion whose drain was removed within 24 hours (28% vs 69%, p=0.01), and consumed fewer dosages of oral analgesics within 48 hours (8 vs 5, p=0.001). Classification of the fracture pattern in 21 of 38 patients were consistent between the surgeon and observer. The Kappa value for agreement was 0.32, denoting marginal agreement (p=0.003). Reduction quality (p=0.66) and bone healing time (p=0.73) assessed by the observer were not significantly different between the 2 groups. The short-term clinical outcome of mini-incision DHS fixation for geriatric pertrochanteric fractures was favourable.

Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures

To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures. Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification. The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6-degree varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3. The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.

The need for routine postoperative radiographs in hip fracture fixation: an audit-based approach

This study was designed to establish whether obtaining routine postoperative radiographs following dynamic hip screw (DHS) fixation served any useful clinical purpose. Fifty orthopaedic units in United Kingdom were randomly selected and surveyed, 18 of which routinely obtained check radiographs following DHS fixation. In our unit, routine postoperative films were being performed despite adequate image intensifier images being obtained and printed in theatre. In this study, 174 DHS fixations were reviewed and assessed for adequacy of image intensifier images by comparing them with formal postoperative radiographs. Hundred and fifteen of the 174 original fractures were deemed stable and showed no change of position of fracture or metal work on the postoperative films. Fifty-nine fractures were unstable, and of these, 14 were shown to have medialization of the femoral shaft on the postoperative radiographs as compared with the image intensifier images. The case notes of 132 of the total number of cases were reviewed and none of these patients underwent a change in postoperative mobilization status based on postoperative radiographic findings. These included the 14 unstable fractures. We conclude that obtaining routine check postoperative radiographs after DHS fixation is unnecessary provided adequate image intensifier images are obtained at the time of surgery.

No advantages of Gamma nail over sliding hip screw in the management of peritrochanteric hip fractures: A meta-analysis of randomized controlled trials

Purpose. There is a lack of consensus regarding the best option for the operative treatment of peritrochanteric fractures. A meta-analysis was performed to assess the surgical outcomes of peritrochanteric fractures.Methods. Only prospective, randomized studies comparing Gamma nail and sliding hip screw (SHS) fixation in adults were included. Eleven studies met the inclusion criteria: the target population consisted of patients with peritrochanteric fractures, while subtrochanteric fractures were not included; the intervention was SHS compared with Gamma nail; the study was a published randomized trial. Each outcome measure tested was assessed for heterogeneity. If significant heterogeneity was present, data from the studies were not combined. If there was no significant heterogeneity, a combined relative risk was calculated using a fixed effects model and a Z-test was performed to test the overall effect.Results. A total of 1344 peritrochanteric fractures entered into the included studies. There were no differences of mortality, cut-out, non-union, re-operation, wound infection, intra-operative fractures of femur, blood loss or surgical time.Conclusions. It seemed that there were no obvious advantages of Gamma nail fixation over SHS fixation in treating peritrochanteric fractures.

Radiation exposure to patients in lower limb trauma surgery

Fluoroscopy equipments have enabled us to perform operations that otherwise would be impossible but only at the expense of exposing the patients and theatre staff to radiation. The aim of this study was to determine the average radiation exposure to the patients in dynamic hip screw (DHS) fixation, cannulated hip screw (CHS) fixation, intra-medullary nailing (IMN) of femur and tibia operations. The records of all patients undergoing the above operations between May 2000 and August 2003 were retrospectively reviewed. A total of 670 patients were included. 389 had DHS, 85 had CHS, 125 had IMN of femur and 71 had IMN of tibia operations. The average radiation time was 0.7, 1.1, 2.5 and 2.1 min and the average radiation dose (in dose area product-DAP) was 196, 356, 548 and 125 cGy cm2 for DHS, CHS, IMN of femur and IMN of tibia, respectively. Compared to the registrars, radiation time and dose were higher with the consultants in DHS fixation (P = 0.02, 0.02). The radiation dose was higher with the senior house officers compared to the registrars in CHS fixation (P = 0.03). There were no significant differences between the consultants and the registrars in IM nailing operations. The study concludes that radiation exposure to the patients in DHS and CHS operations depends on the experience of the surgeon but not in IMN operations. The IMN of femur involved more than four times higher radiation than IMN of tibia and the CHS fixation involved double the radiation than the DHS fixation. The radiation time was poor comparative metric to estimate radiation dose.

Trauma surgery and risk of radiation injury to patients

Image intensifiers are widely used in orthopaedic trauma surgery. Since beginning of fluoroscopy use, concerns have been raised regarding the radiation risks to the patients and the theatre staff in these operations. The radiation risks are classified into two types, stochastic and deterministic risks. Effective dose (ED) and skin dose (SD) values were derived from dose area product (DAP) values and used to quantify the stochastic and deterministic risks, respectively. Patients (670) who had dynamic hip screw (DHS) fixation, cannulated hip screw (CHS) fixation, intra-medullary nailing (IMN) of femur and tibia were included in the study. ED values were 0.3, 0.6, 0.9 and 0.01 mSv and stochastic risks were 3 × 10−5, 6 × 10−5, 9 × 10−5 and 1 × 10−6 for DHS, CHS, IMN of femur and IMN of tibia, respectively. Maximum SD values were 36, 65, 100 and 46 mGy which were only 2, 3, 5 and 2% of threshold dose for temporary skin erythema (2 Gy) in DHS, CHS, IMN of femur and IMN of tibia operations. The radiation exposure in these operations was very low compared to common intervention radiology procedures. The study concludes that the risk of radiation injury in lower limb trauma surgery is extremely small. The radiation doses to patients are within maximum permissible dose (MPD) limits recommended by International Commission on Radiological Protection.

Vergleichende Stabilitätsuntersuchungen an DHS- und DHN-Osteosynthesen subkapitaler Pauwels-III-Osteotomien als Modell höhergradig instabiler medialer Schenkelhalsfrakturen

High failure rates due to instability and redisplacement are reported using the dynamic hip screw-fixation of femoral neck fractures in the elderly. This fact was the reason for the development of the dynamic hip nail (DHN) which has a TU cross-section profile and should provide more resistance against cutting through the femoral head trabecular bone than the commonly used DHS. For a comparing stability investigation fixation of vertical femoral neck osteotomies in eight pairs of macroscopically normal cadaver femora was performed with either the DHS supplemented proximally with a parallel 6.5 mm cancellous screw or the DHN. Fixed in a testing machine at an adduction angle of 9° the specimens were vertically loaded from 1 kN up to 4.5 kN with a stepwise increase of 0.5 kN and 500 load cycles within each load level. The applied loads were increased until a distal displacement of the femoral heads of 2 mm was measured. From the recorded loads and number of cycles at the 2 mm distal head displacement the overall load bearing capacity of the DHS- and DHN-osteosyntheses were calculated in kN. The test results indicated that the DHN provided a much more stronger support for the femoral head against dynamic vertical compression loads than the DHS. In three of the eight DHN-osteosyntheses the 2 mm distal head displacement did not occur after 500 cycles at the maximal load of 4.5 kN. The mean overall load bearing capacity of the DHS-osteosyntheses at the 2 mm distal head displacement was 4301,4 kN and that of the DHN-osteosyntheses was 8332,3 kN. Especially in the pairs of femora with weak bone the DHN provided a much more higher resistance against cutting through than the DHS. From the biomechanical standpoint the results indicate that the DHN seems to be a more saver device for the fixation of femoral neck fractures than the DHS.

Operative Stabilization of Subtrochanteric Fractures of the Femur

The records and radiographs of 35 patients with 36 fractures of the subtrochanteric area of the femur stabilized by either angle blade plate (ABP) or dynamic hip screw (DHS) fixation were retrospectively reviewed to evaluate and compare the efficacy of these two implants in the management of these injuries. Twenty of the 36 fractures were managed by ABP stabilization and 16 fractures by DHS stabilization. In each case, a priority was placed on reconstitution of the medial cortex, either by anatomic reduction and stabilization or by the liberal use of cancellous bone grafting. The patients were evaluated for fracture pattern, integrity of the reconstructed medial cortex, time to union, and complications related to implant use. The two fracture classification systems used in this report (Waddell or Sensheimer), although helpful in preoperative planning, did not provide prognostic insight into fracture healing. All 31 fractures with an acceptable reconstitution of the medial cortex united primarily. Three of the five fractures without an acceptable medial buttress united primarily, one required reoperation for a delayed union with implant failure, and one patient had a fatal pulmonary embolism. This study demonstrates the acceptability of either implant in the management of subtrochanteric fractures provided strict adherence to reconstruction of the medial cortex is accomplished.