Treatment of reverse oblique trochanteric femoral fractures with proximal intramedullary femoral nail and plate

Introduction The incidence of proximal femoral fractures has increased with a greater number of patients who are in the elderly population with osteoporosis. Reverse oblique fractures is a unique fracture pattern that is anatomically and mechanically different from the other trochanteric fractures. The fracture line extends from the proximal medial cortex out through the distal lateral cortex. Thus it is more difficult to treat due to medial displacement of femoral shaft. Reverse oblique fractures have two main types of implants available, which are the dynamic hip screw (DHS) and intramedullary implants. However, there is a high rate of incidence of fixation failures when the dynamic hip screw are used, due to the anatomical structure of the reverse oblique fracture which would result in a varus deformity of the fracture during the recovery phase. Methods The surgery involves a stainless-steel intramedullary nail, 2.7 mm mini plate with 3 screws. Discussion Dynamic Hip Screw can be used to fix reverse oblique fractures, however, it results in extensive medialization of the shaft and poor fracture healing, resulting in higher risk of implant failure. Conversely, intramedullary femoral nail can also result in lateral migration of fracture fragments, hindering effective reduction. Thus in this study, 2.7 mm mini plates and 3 screws are used to counter the virus movement of the muscles to achieve good reduction. By using 3 screws, it provides better rotational control of the proximal fracture fragment and decrease the cut out of the femoral head by preventing toggling of the proximal fragment.