Intramedullary Nailing for the Management of Intertrochanteric and Subtrochanteric Geriatric Fractures

The number of hip fractures worldwide has been estimated to increase from 1.22 million in 1990 to an estimated 2.6 million in 2006.1,19 With union rates greater than 95%, the sliding hip screw and plate construct represents the current standard of treatment for peritrochanteric femur fractures. However, complications associated with sliding hip screw and plate systems have generated a considerable amount of interest in the use of intramedullary implants for these common fractures. Limited open techniques offer the potential for less blood loss and soft tissue insult, thus decreasing the potential for perioperative complications while allowing rapid mobilization and return to preinjury function. Intramedullary implants also represent biomechanical improvements from conventional sliding hip screw and side plate constructs, theoretically reducing the incidence of screw cutout, excess collapse at the fracture site, and implant failure. This article discusses the rationale for treatment with the intramedullary hip screw over the sliding hip screw and side plate, describes the techniques of reduction as well as percutaneous adjuncts to treatment, examines some of the special situations that strongly support its use, and reviews the early and recent outcomes of this treatment.