IMHS in peritrochanteric fractures

Internal fixation of fractures of the proximal femur is one of the most common trauma operations in the UK. While stable fractures have been successfully treated with sliding hip screws for many years with a low rate of complications, there has been much debate about the right choice of implant for the treatment of unstable and sub-trochanteric fractures. We present a series of 45 patients with inter- and sub-trochanteric fractures and pathological lesions who were treated with the Intramedullary Hip Screw (IMHS). All notes and radiographs were reviewed and there was an emphasis on the quality of reduction and the position of the metalwork. The commonest postoperative complication was superior cut-out of the sliding screw in four patients (8.8%). Varus position after reduction and superior screw position were present in these patients. Two of the patients were converted to IMHS fixation after previous failure of dynamic hip screw (DHS)/dynamic condylar screw (DCS) fixation. All four patients were treated non-operatively until the fractures were healed. We conclude that IMHS fixation is a viable option for unstable and pathological inter- and sub-trochanteric fractures of the femur. Varus reduction and superior position of the sliding screw have to be avoided. In revision cases there is a high rate of failure. (Hip International 2005; 15: 27-32).