Rotational Instability and Complications Following Extracapsular Hip Fracture Fixation

Successful management of extracapsular hip fractures requires a comprehensive understanding of fracture stability to optimize outcomes and help prevent mechanical failures. Currently, the definition of stability is imperfect, as demonstrated by continued failure and moderate-to-severe collapse observed in stable fractures. Adopting a more three-dimensional approach has led to a greater understanding of the role of rotational instability in mechanical failures, and torsion control devices are now becoming more readily available as part of the most recent generation of cephalomedullary nails. Although new technology can be useful when used appropriately, new products alone are neither able to completely eliminate failures nor do they obviate the need for a good reduction or good surgical technique. The management of complications following extracapsular hip fracture fixation now involves a more inclusive definition of failure to address the loss of independence reflected in the functional outcomes associated with these injuries. In the presence of combined radiographic and clinical failure, early revision surgery can immediately improve mobility and outcome.