Intertrochanteric Fractures: Ten Commandments for Getting Good Results with Proximal Femoral Nailing

Area of Science:

• Orthopaedic surgery
• Geriatric trauma
• Biomedical engineering

Background:

• Intertrochanteric fractures in the elderly present significant challenges due to poor bone quality and comorbidities.
• These fractures are associated with high mortality rates (nearly one-third within a year) and substantial healthcare costs.
• Historically, treatment varied based on fracture stability, with surface implants for stable and intramedullary devices for unstable patterns.

Purpose of the Study:

• To review current evidence on intertrochanteric fracture fixation in the elderly.
• To present ten key principles for successful intertrochanteric fracture management using proximal femoral nails (PFN).
• To advocate for intramedullary fixation as the preferred treatment modality.

Main Methods:

• Review of historical treatment practices and recent evidence, including Cochrane reviews.
• Analysis of clinical experience in managing intertrochanteric fractures.
• Emphasis on achieving and maintaining optimal fracture reduction.

Main Results:

• Current evidence supports intramedullary implants as the preferred fixation method for both stable and unstable intertrochanteric fractures.
• Optimal fracture reduction is directly correlated with surgical success.
• Intramedullary devices effectively maintain alignment once adequate reduction is achieved.

Conclusions:

• Intramedullary fixation, specifically using dual-screw trochanteric fixation nails (TFN), is recommended for elderly patients with intertrochanteric fractures.
• Dual-screw TFNs offer enhanced stability compared to single-screw systems.
• Surgical expertise in reduction and fixation is critical for optimal patient outcomes.