Of 622 intertrochanteric fractures, 57% were stable (Types I and II).
Twenty-eight per cent were Type III, and 15% were Type IV (the unstable
types). The 150-degree telescoping Massie nail proved superior to the fixed
135-degree Jewett nail (particularly for unstable fractures) because it
allowed a controlled impaction of the fracture fragments to a stable
position. In about one-third of the fractures, some medial displacement
occurred. With anatomical reduction and the use of the Massie or ASIF
nails, we achieved a decrease in the morbidity and mortality and 96%
satisfactory results. Our prospective study was compared with a
retrospective study in which other devices were used. Early ambulation and
weight-bearing also was a major contributing factor to the improved results
in the prospective study. Intertrochanteric hip fractures that are unstable
can be fixed with a collapsible nail, and that treatment appears to give as
good or better results than the displacement method of Dimon and Hughston
or Sarmiento.