Intramedullary Stabilization of Proximal Femoral Fractures

For nearly 40 years, extramedullary stabilization using the sliding hip screw and plate has been the standard fixation method for proximal femoral fractures. In patients with stable fractures, this device produces excellent results. However, in patients with unstable fractures, the sliding hip screw and plate is associated with an increased prevalence of complications, particularly cut-out, medialization of the shaft, shortening, and subsequent loss of reduction. For these reasons, there has been a sustained interest in the use of an intramedullary nail to treat proximal femoral fractures. However, intramedullary methods of therapy for trochanteric fractures require extensive operative experience. The incidence of complications, e.g. cut-out, femoral shaft fractures, and the learning curve has resulted in a loss off popularity of these devices in the past. The aim of this overview is to analyze and record the current standards by means of recent papers and to present the experience after intramedullary stabilization of more than 3,000 patients with proximal femoral fractures at our level I trauma center.