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A Journal on Orthopedics and Traumatology

Official Journal of the Piedmontese-Ligurian-Lombard Society of Orthopedics and Traumatology
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Minerva Ortopedica e Traumatologica 2009 December;60(6):515-26

language: English

Intramedullary nails in the treatment of extracapsular hip fractures

Desy N. M., Bergeron S. G., Berry G. K., Reindl R., Harvey E. J.

Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada


Proximal femur fractures or hip fractures are common injuries treated by orthopedic surgeons. A large proportion of these hip fractures are extracapsular, consisting of intertro-chanteric or reverse obliquity fractures. Ideally, they should be treated promptly with the goal of restoring function to the affected extremity, allowing early mobilization and return to baseline activities. Most of these fractures are treated adequately with some of the most tried and tested methods in orthopaedic surgery. There remain some subgroups of these fractures that are in the process of being more clearly defined, for which new treatment modalities and approaches are being devised. Extraca-psular hip fractures have been traditionally treated with an extramedullary implant, most commonly the compression hip screw. Over the last few years, intramedullary devices have gained popularity and are rapidly replacing the compression hip screw as the implant of choice despite a lack of clear evidence that demonstrates a definitive superiority. We review the current literature for the treatment of extracapsular proximal femur fractures, namely intertrochanteric and reverse obliquity fractures, and provide the most recent biomechanical and clinical evidence to support the use of either an intramedullary or extramedullary device. Earlier generation intramedullary implants demonstrated a higher complication rate, mostly from perioperative and postoperative femoral shaft fractures. Newer implant designs have shown a reduction in the rate of complications compared to older intramedullary nails although there is still no clear advantage of these implants over extramedullary devices in the fixation of stable and unstable intertrochanteric fractures. However, the preferred treatment method for reverse obliquity intertrochanteric fractures is an intramedullary device.

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