Intramedullary nailing in pertrochanteric fractures of the proximal femur

Pertrochanteric fractures of the proximal femur should be treated surgically, unless the medical condition of the patient does not allow it. Currently, there are two ways to fix these fractures; either with a sliding hip screw or with an intramedullary nail. However, there is much debate over which implant is the best for pertrochanteric fracture fixation. The sliding hip screw has been used over time with good clinical results. While it was true that with first generation intramedullary nails the risk of complications was higher, there is evidence supporting the superiority of intramedullary nails in these fractures when compared with sliding hip screws. This evidence is based on the good clinical results and fewer complications, due to an improvement in the design of the implants and surgical technique used by surgeons. In stable fractures, despite the method chosen for fixation, obtaining a good reduction prior to placing the implant is the most important factor that can be controlled by the surgeon. In stable fractures the surgeon experience is a strong factor to account for when choosing the type of implant. Clearly there are fracture patterns (reverse oblique and subtrochanteric extension) that benefit from the use of intramedullary devices due to the high risk of failure if plates are used.

It is very important that the surgeon identifies these fractures, so the type of fixation device which is chosen achieves the greatest stability possible. The aim of this paper is not to convince the surgeon about using intramedullary nails, but highlight the potential benefits intramedullary nailing has when compared with the use of extramedullary devices.