Abstract
Trochanteric fractures may be divided into two basic groups - pertrochanteric (31A1+2) and intertrochanteric (31A3, high subtrochanteric) and each of them further into stable and unstable ones. With the exception of fractures in case of osteoarthritis, the method of choice is internal fixation.
The choice of the implant and a suitable surgical technique must be based on the biomechanical assessment of the fracture including the quality of bone. Stable fractures do not pose any significant therapeutic problem, however, it is often difficult to distinguish them from the un-stable ones.
There exist two types of instability - varus and medial. Both these complications may be prevented in most cases by a correct surgical technique.
In pertrochanteric unstable fractures the method of choice is DHS or PFN. The application of DHS, however, requires 140° valgus reduction and, if need be, combination with a trochanteric plate pre-venting medial instability.
PFN does not require such a great valgus reduction as the stem of the nail substitutes the Adams's arch. In intertrochanteric unstable fractures the method of choice is a intramedullary nail.
However, in distal locking it is necesary to prevent distraction between the trochanteric massif and the femoral shaft. The most frequent complication is varus failure of the internal fixation.
All this can be satisfactorily addressed by intertrochanteric valgus osteotomy.