Extramedullary versus intramedullary bone fixation Treatment of peritrochanteric fractures

Abstract

Half of hip fractures in the elderly are intertrochacnteric fractures, more than 50% of this fractures are unstable (1,2). Fractures of intertrochanteric region are more common than femoral neck since it has a thinner cortical bone and it occurs more commonly in elderly due to decrease bone density in old age(3). Trochanteric fractures surgery aims to early recovery and prevention of further complications. The most common system used for classification of intertrochanteric fractures is AO system (4). AO classifications divide intertrochanteric fractures into four types: stable trochanteric (Type A1), unstable trochanteric (Type A2), fractures at the lesser trochanter (Type A3) and subtrochanteric fractures. In the last few decades dynamic hip screws was the gold standard in fixation of trochanteric fractures (5). But in unstable fracture higher rates of failures nearing 23% have been reported when using dynamic hip screws (6). On other hand intramedullary nailing system has theoretical clinically and mechanical advantages than dynamic hip screw (7). Most authors depends on nailing system on treatment of unstable trochanteric fractures as its provides higher stability in this conditions (8,9,10). But numerous complications reported from intramedullary nailing system such as intraoperative intertrochantric fractures, difficultly in targeting the cephalic screw, postoperative fractures at the