Is Helical Blade Nailing Superior to Locked Minimally Invasive Plating in Unstable Pertrochanteric Fractures?

Abstract

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany?

“…These mainly reverse fracture patterns are difficult to treat, especially when associated with a medial component. That is why these reversed fractures with a broken lateral wall should be fixed with current intramedullary systems [14,21]. As a detached greater trochanter appears to be a key element for stability and the choice of implant, current classifications may need to be revised accordingly [34,44].…”

“…The treatment for unstable intertrochanteric femur fractures is unclear and has been associated with a mechanical complication rate of 0% to 20% [3,21,24,28,40,45]. An reoperation rate of less than 3% by only 2 .…”

“…The survey also included questions regarding hospital sizes, hospital levels in Germany [8], geographic locations, department characteristics, and number of intertrochanteric femur fractures treated per year (self-reported measures) ( Table 1). Items 1 to 3 contained questions about demographic data, Item 4 timing of surgery [1,7,29,32,42], Items 5 and 6 classification systems (including AO/OTA [30] and Evans [11]) and instability criteria [11,17,30,44], Items 7 to 10 implant selection, Items 11 to 15 surgeon, patient positioning, and estimation of surgical and radiographic screening time, Items 16 to 18 weightbearing, hospitalization time, and discharge procedure, Item 19 expected complications, Items 20 and 21 importance of cement augmentation and minimally invasive extramedullary systems [13,21,23,24,26,39], Items 22 to 24 radiographic evaluation, reoperation rate, and importance of outcome scores, Item 25 main problems in unstable intertrochanteric fracture treatment, and Item 26 willingness to participate in a multicenter study.…”

“…Over the last 30 years, new techniques and implants reportedly have minimized complications while promoting early rehabilitation [2, 3, 13, 18, 21-24, 28, 35, 38-40, 43, 45]. The intramedullary hip screw (IMHS) has become a common internal fixation strategy, heralded for its biomechanical superiority [16,25] and minimally invasive application [2,3,18,21,28,38,40,45] compared to more traditional extramedullary techniques, such as the sliding hip screw (SHS) [2,3,5,18,23,35,37] or the newer locked minimally invasive plates [13,21,23,24,26,39].…”

“…Definitions of unstable fractures vary but include those with a fractured lesser trochanter [3,21,24,30,38], reverse fracture line or intertrochanteric comminution associated with a big posteromedial component [10,11], a broken greater trochanter [34], and lateral cortex breach [14,33]. Despite the use of current techniques and implants, treatment failure ranges from 0% to 20% [3,21,24,28,40,45].…”