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Hip Fractures: II. Evaluation and Treatment of Intertrochanteric Fractures

Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York.

Surgical stabilization followed by early mobilization is the treatment of choice for both nondisplaced and displaced intertrochanteric fractures. Fracture stability is dependent on the status of the posteromedial cortex. The sliding hip screw is the device mostly commonly used for fracture stabilization. The most important aspect of its insertion is secure placement within the femoral head. Although the sliding hip screw allows postoperative fracture impaction, it is essential to obtain an impacted reduction at the time of surgery. If there is a large posteromedial fragment, an attempt should be made to internally fix the fragment with a lag screw or cerclage wire. Although intramedullary hip screws have not been shown to be superior to the sliding hip screw, they may have selected indications.

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