Commentary: Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant.

fractures with an intact posteromedial buttress, have been successfully treated with a sliding hip screw or blade.1 However, unstable intertrochanteric fractures tend to collapse even after adequate reduction and fixation with plating, and thus intramedullary nailing is recommended.2 Unstable intertrochanteric fractures include fractures with posteromedial comminution, a reverse oblique configuration, subtrochanteric extension, lateral wall fractures, or a split in the coronal plane. The ‘lateral wall’ is important in the stability of intertrochanteric fractures.3 Intertrochanteric fractures with an intact lateral wall are stable enough to prevent excessive collapse and medialisation of the shaft. However, the presence of a lateral wall fracture converts a simple fracture to a reverse oblique fracture.4 Lateral wall thickness is defined as the distance from a reference point 3 cm below the vastus ridge or innominate tubercle of the greater trochanter angled at 135o upwards to the fracture line on anteroposterior radiographs. It is a reliable predictor for the risk of lateral wall fracture. If the lateral wall thickness is >20.5 mm, a sliding hip screw can be Commentary: Morphology and fixation pitfalls of a highly unstable intertrochanteric fracture variant