Nailing of displaced intertrochanteric hip fractures

Trochanteric femur fractures still represent major challenges with regard to prevention, treatment, and functional recovery. These challenges are magnified in unstable, displaced intertrochanteric hip fractures with significant mortality, morbidity, and financial repercussions. A refinement in the goals of treatment have shifted our focus to early weightbearing ambulatory mobilization and prevention of deformity in the elderly patient. Whereas traditional fixation techniques developed in the 1940s represented the previous state of the art, nowadays those treatments are being critically evaluated and compared with improvements in cephalomedullary nails, new plate designs, and vascularity-preserving surgical techniques. Modern designs and minimally invasive surgical techniques have enlarged the indications for intramedullary fracture fixation. The development of interlocking screws into the femoral head improves the capability of obtaining stable fixations of the head-neck complex of even displaced multifragmentary femur fractures. Difficulties persist in attaining the reduction and construction of stable fixation of displaced intertrochanteric multifragmented hip fractures. This paper contains detailed instructions and recommended procedures for reduction and fixation of complicated trochanteric hip fractures with cephalomedullary nails.