Background: Intertrochanteric fractures are composed of different anatomic patterns that vary in their degree of stability following open reduction and internal fixation. A particularly unstable group is classified as AO/OTA 31-A3, with the fracture pattern described as reverse oblique or transverse. The purpose of this study was to compare the results of intramedullary fixation with those of plate fixation for these intertrochanteric fractures in elderly patients.

Methods: Thirty-nine elderly patients with AO/OTA 31-A3 intertrochanteric fractures of the femur were randomized into two treatment groups and were followed for a minimum of one year. The nineteen patients in Group I were treated with a 95° fixed-angle screw-plate (Dynamic Condylar Screw), and the twenty patients in Group II were treated with an intramedullary nail (Proximal Femoral Nail). The treatment groups were comparable with regard to all demographic and injury variables.

Results: Patients treated with an intramedullary nail had shorter operative times, fewer blood transfusions, and shorter hospital stays compared with those treated with a 95° screw-plate. Implant failure and/or nonunion was noted in seven of the nineteen patients who had been treated with the 95° screw-plate. Only one of the twenty fractures that had been treated with an intramedullary nail did not heal.

Conclusion: The results of our study support the use of an intramedullary nail rather than a 95° screw-plate for the fixation of reverse oblique and transverse intertrochanteric fractures in elderly patients.