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Unstable Intertrochanteric Hip Fractures in the Elderly

Dr. Lindskog is Instructor, Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT. Dr. Baumgaertner is Associate Professor and Chief, Section of Orthopaedic Trauma, Department of Orthopaedics and Rehabilitation, Yale University.

Reprint requests: Dr. Baumgaertner, Yale University, PO Box 208071, 800 Howard Avenue, New Haven, CT 06520-8071.

Unstable intertrochanteric hip fractures account for approximately one quarter of all hip fractures in the elderly and are increasing in frequency. Treatment goals include immediate mobilization while limiting complications. Preoperatively, medical comorbidities should be identified and managed. For stable intertrochanteric hip fractures, consistently good results have been achieved with compression hip screw fixation. However, with more unstable fracture patterns, problems with compression hip screw fixation, such as excessive fracture collapse and implant cutout, increase. For these fractures, adding a trochanteric stabilizing plate or using an axial compression hip screw or intramedullary hip screw is warranted. Surgical care should maximize the patient’s chance of a successful outcome by realigning the fracture with minimal additional surgical insult, selecting the appropriate implant, and positioning it properly.

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