Intertrochanteric femur fractures: a current concepts review

Intertrochanteric fractures are common injuries around the hip, especially among elderly. With rising incidence of these injuries, they expected to double by 2050. Incidence rates higher in females than males and white patients black African patients. Osteoporosis weakens local trochanteric anatomic support leading an increased susceptibility fractures. Disruption posteromedial calcar region results fracture instability. Optimal lag screw position reduction significant determinants for postoperative outcomes. The tip apex distance criteria determine cut-out risk quality, respectively. A calcar-referenced is comparable if not better predicting risk. slight valgus, a positive medial cortex apposition smooth anterior apposition. High mortality observed with non-surgical treatment. Surgical management therefore gold standard intertrochanteric Treatment options categorised into extramedullary fixation, intramedullary fixation proximal femur replacement. They include dynamic hip (DHS), cephalomedullary nails (CMN) arthroplasty. Although still use, locking plate falling out favour due high complication rates. Fracture stability pattern influence treatment choice. There is, however, growing use CMNs which has been attributed surgical training background. Modification older CMN designs improved Systematic meta-analyses randomised controlled trials (RCTs) do show superiority one option over another; therefore, there no consensus on best nail antirotation (PFNA) outcomes compared other respect intraoperative blood loss Harris scores. As group, have 120-day quality life DHS. No difference complications found between options. In light anticipated fracture, more work needed planning national resource allocation, devising preventative methods improving clinical interventions South Africa. Level evidence: 5