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Intramedullary Nailing pp 185–206Cite as

Pertrochanteric Fractures

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Abstract

Pertrochanteric fractures represent an important health issue. The goal of treatment is to restore function and pre-injury level of independence. This chapter discusses indications, surgical technique and postoperative outcome of intramedullary fixation. Fracture stability is the clinical most important determinant. Whereas stable fractures will withstand medial compressive forces after fixation, unstable fractures will collapse and/or displace under medial compressive forces despite axial reduction. Intramedullary devices have the theoretical advantage of more efficient load transfer due to its proximity to the medial calcar compared to extramedullary implants as well as less implant strain because of its closer positioning to the mechanical axis of the femur resulting in a shorter lever arm. A precise intramedullary nail starting point and skillful operative technique reduces this risk of iatrogenic neurovascular or musculotendinous injury. The reduction of the pertrochanteric fracture is recommended prior to placement of the intramedullary nail. Correct placement of the nail prevents postoperative complications and assures uneventful healing. Outcome is depending on the preoperative condition of the patient and the quality of reduction and fixation.

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Authors and Affiliations

  1. Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital/Weill Cornell Medical College, 535 East 70th St., New York, NY, 10021, USA

    Dean G. Lorich MD

  2. Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA

    Richard M. Hinds MD & Patrick C. Schottel MD

  3. Department of Orthopaedic Surgery, Toyama Municipal Hospital, 2-1 Imaizumihokubu, Toyama City, 939-8511, Japan

    Takeshi Sawaguchi MD

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  1. Dean G. Lorich MD
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  2. Richard M. Hinds MD
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  3. Patrick C. Schottel MD
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  4. Takeshi Sawaguchi MD
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Correspondence to Dean G. Lorich MD .

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Editors and Affiliations

  1. Center for Orthopedics &Traumatology, University Medical Center Johannes Gutenberg University, Mainz, Germany

    Pol M. Rommens

  2. Academic Teaching Hospital Fulda, Fulda, Germany

    Martin H. Hessmann

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Lorich, D.G., Hinds, R.M., Schottel, P.C., Sawaguchi, T. (2015). Pertrochanteric Fractures. In: Rommens, P., Hessmann, M. (eds) Intramedullary Nailing. Springer, London. https://doi.org/10.1007/978-1-4471-6612-2_16

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