Osteoporotic pertrochanteric hip fractures: management and current controversies

The treatment of intertrochanteric hip fractures has evolved over the past 80 years because of a better understanding of fracture anatomy, application of biomechanical principles, and novel technologic advances. Surgical treatment of intertrochanteric hip fractures is the current standard of care, with short-term goals of fracture stabilization and early patient mobilization and the long-term objective of restoring patients to their previous level of independence and function. Treatment for stable intertrochanteric hip fractures includes use of percutaneous intramedullary devices and open reduction and internal fixation using a sliding hip screw. To date, none of these devices has shown any clear clinical advantage over the dynamic hip screw. Intramedullary fixation has multiple theoretical advantages for the treatment of unstable fracture patterns; however, it remains unclear if ultimate functional outcome warrants the added expense of such treatment. For patients with a reverse obliquity fracture pattern, the advantage of the intramedullary construct has been shown.