3. Epidemiology
• 50% of all hip fractures
• Elderly patient: low energy fall + osteoporosis
• Female-male ratio 2:1
• 20-30% mortality first year
• High failure rate 4-12%
7. Blade plate
Compare to Sliding implant
• Cut-out: 13% vs 4%
• Non union: 2% vs 0.5%
• Implant breakage: 14% vs 0.7%
• Re-operation: 10% vs 4%
• Higher mortality, residual pain,
impaired mobility
The continued use of Fixed nail
plates cannot be justified
8. Sliding HS Dynamic compression
Dynamic interfragmentary
compression
Gold standard for hip
fracture 1980's – 2000
1955 - Schumpelick and
Jantzen
11. Sliding HS Dynamic compression
Medialization of the shaft up to
90% (Rale et al 1993)
Still useful for A1 stable fracture (Parker et al
– meta analysis)
13. IM Nail
•First generation of Gamma nail
•Early mobilization, full weight
bearing
•Unstable fracture
There was no evidence for a
reduced failure rate with IMN in
unstable trochanteric fractures.
14. IM Nail
The gamma nail cannot be
recommended for routine use in
trochanteric fractures until the
problem of femoral shaft
fracture is resolved.
• SHS lower complication rate
• Different types of intramedullary nail
produce similar results?
• Intramedullary nails have advantages
for selected fracture types?
19. Locking Plate
PFLP was not an
appropriate treatment for
trochanteric fractures
PFLP is not universally
effective in treating
IT fractures.
Femoral locked plate
(PFLCP) can give good
healing, with a limited
occurrence of complication
20. Arthroplasty
• Early walking + full weight
bearing
• Reduced pressure ulcer +
pulmonary infection
• No decrease mortality rate
Option for patient >75 yo with
unstable fracture
21. Arthroplasty Total or bipolar
• Dislocation rate: 12% vs Hemi
Geiger et al Arch of Orthop trauma Surgery
2007
• Abandon THA as the luxation rate
was higher than hemiarthroplasty
22. Arthroplasty Cemented or cementless
• The cementation: cement
embolization, non-union,
varying cement mantle
thickness
• non-union greater trochanter
• progressive radiolucent line
23. Arthroplasty Cemented or cementless
Cementless: early mobilization, acceptable
functional results, low implant loosening
rates, shorter surgery time, lesser blood
loss, lower perioperative mortality rate
Satisfactory results: early weight
bearing, early rehabilitation, low rate of
complication
24. Arthroplasty versus internal fixation
• Internal fixation: preferred method for
elderly unstable IT fractures, even
severe osteoporosis
• Nail: equal clinical outcomes
• Arthroplasty: more expensive, operating
time, blood loss, higher mortality rate
• No functional benefit over internal
fixation
25. Summary Implant selection
• Blade plate: abandoned for IT fracture
• DHS: still useful for A1 stable fracture, not recommend in
A3 fracture or A2 unstable fracture
• IM nail: first option for unstable fracture
• Arthroplasty: preexisting OA, pathologic fracture, severe
comminution, severe osteoporosis, salvage procedure
• Locking plate: Piriformis or trochanteric extension, narrow
intramedullary canal, pulmonary injury, abductor
preservation
