Management Options and Treatment Algorithm in Intertrochanteric fractures

Abstract

Background: Intertrochanteric (IT) fractures are one of the most common lower limb fractures. There are many varied treatment options to treat the same. Also, our basic understanding of IT fractures is improving leading to evolution of newer concepts which in turn is leading to designing of newer implants. In this sea of newer treatment options, are all newer implants merely market driven? The new- age orthopaedic surgeon needs to be made aware of the newer concepts of IT fractures, implant designs and also a comprehensive literature support of the various treatment options available like concept of unstable IT farcture, the dynamic hip screw (DHS) system, Medoff’s plate, DHS with a trochanteric stabilization plate, 95 degree Dynamic Condylar Screw, first to third generations of gamma nails, proximal femoral nails (PFN), expandable PFN, InterTAN with integrated interlocking screws, proximal femoral locking plates and use of bipolar hemiarthroplasty. This article also aims to present a practical treatment algorithm for the treatment of IT fractures, but this may not be generalizable to all orthopaedic surgeons. Keywords: Intertrochanteric; unstable; DHS; PFN; Gamma; hemiarthroplasty.