Treatment of intertrochanteric fractures with a sliding nail-plate

Valgus closed reduction and internal fixation with a 150 degrees nail-plate produced favorable results in 55 stable and 45 unstable intertrochanteric fractures. The average axial collapse (impaction) was 14.9 mm in stable fractures and 19.6 mm in unstable fractures. Most (65%) of this spontaneous impaction occurred within the first week. There were six (6.0%) failures of fixation. The two failures (3.6%) among the stable fractures were the result of malpositioning of the internal fixation device. Four (8.8%) unstable fractures demonstrated loss of fixation related to failure to allow sufficient slide within the nail to accommodate the postoperative axial collapse of the fracture fragments. It is recommended that 20 to 25 mm of nail slide be made available in stable fractures and 25 to 30 mm in unstable fractures. This will increase stability by allowing the sliding nail to accommodate the complete post-fixation axial collapse of the fracture fragments.