The management of intertrochanteric fractures

In this paper we discuss the management of pertrochanteric fractures, including intertrochanteric fractures, reverse obliquity intertrochanteric fractures and those fractures with extension to the subtrochanteric region. These fractures remain a significant orthopaedic and societal problem. They occur in challenging patients with poor bone quality and numerous co-morbidities. While a majority of injuries are successfully treated, they continue to have a small but significant incidence of problems. in addition, the secondary issues related to patient recovery remain unaddressed. The mainstream devices used for their treatment are the dynamic compression hip screw and side plate and the intramedullary hip screw. The surgeon should not try to determine or opine whether one of these devices is superior to the other but instead should determine what has the best results in their hands. While there are differences in certain situations, a reasonable implant placed correctly has the best chance of success. Other devices such as angled compression screws or blade plates are useful for specific fractures and reconstruction situations but require greater attention to technical placement. The best investment for scientific effort would be to prevent the fracture from occurring to begin with. Whether from increasing bone density or reducing traumatic events, prevention will result in significantly less morbidity and societal costs.