Extramedullary fixation of trochanteric hip fracture

Extramedullary fixation with a sliding hip screw remains the treatment of choice for the majority of trochanteric hip fractures. Attention to surgical detail is far more important that the actual choice of implant. The fracture must be reduced to an anatomical or slight valgus position using the fracture table. Surgical exposure need not be excessive as most fractures can be reduced by closed means. The position of the lag screw is critical to achieve a central to inferior position on the anterior-posterior radiograph and a central position on the lateral view. A four-hole plate should suffice for most fractures. After surgery, weight bearing as able should be allowed. For fractures fixed correctly, wound or fracture healing complication should be rare, occurring in <5 % of cases.