Extract
Currently, the most common treatment of peritrochanteric fractures is
surgical stabilization with use of either a compression hip screw or an
intramedullary hip screw and early mobilization of the
patient1-3.
The compression hip screw provides secure fixation and controlled impaction of
the fracture, but use of this device in the treatment of fractures with
posteromedial comminution and subtrochanteric extension can be
problematic4,5.
Cephalomedullary nails combine the advantages of intramedullary fixation with
those of a sliding screw. Such devices are load-sharing and offer a decreased
bending strain, because the moment arm is reduced. These devices may also
offer a biological advantage by combining a closed surgical technique with
limited periosteal
disruption6. Some of
the problems encountered with intramedullary devices have been fracture
propagation, difficulties with interlocking, stress mismatch, and jamming of
the compression screw within the nail. If there is no sliding, the implant
essentially functions as a fixed-angle device. This may result in screw
migration, cutout, or
failure2,7.