Background: Unstable intertrochanteric (IT) fractures are common orthopedic injuries in elderly with high morbidity. The treatment of unstable IT fractures with Sliding Hip Screw (SHS) is still controversial. The purpose of our study is to assess the outcomes of conventional SHS in unstable IT fractures in comparison to stable ones.Methods: Thirty-five stable and 23 unstable IT fractures retrospective cases treated with SHS between January 2017 and December 2018. Patients were evaluated for infection, revision rate, screw cut-out, the development of post-traumatic arthritis or heterotopic ossification and mortality. Results: Mean age of the patients at the time of surgery was 69.8 and 73.9 years for stable and unstable IT fractures, retrospectively, with 38 males and 20 females. The mean follow-up of 45.9 weeks. We found significant association between occurrence of SHS screw cutout and unstable fractures compared to stable ones (0% versus 17.4%, respectively, p = 0.01). There was an obvious trend for non-union and higher revision rate in unstable IT fractures (17.4% vs. 2.9%, p = 0.056). Logistic regression analysis didn’t reveal any statistically significant confounder that might affect the rates of fracture union or revision rates. Post-traumatic arthritis and heterotopic ossification occurred in one case of unstable IT fracture. There were no reported cases of infection.Conclusion: There is high risk of screw cutout, nonunion and revision using the SHS in unstable intertrochanteric fractures (AO type A2.2 and A2.3) compared to stable ones (AO type A2.1). Therefore, other modalities are preferred for the fixation of unstable IT fractures. Level of Evidence: III
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