Version 1
: Received: 22 April 2024 / Approved: 22 April 2024 / Online: 23 April 2024 (03:31:02 CEST)
How to cite:
Rodriguez-Merchan, E.C.; Delgado-Martinez, A.D. Current Concepts on the Treatment of Intertrochanteric Fractures to Prevent Nonunion. Preprints2024, 2024041406. https://doi.org/10.20944/preprints202404.1406.v1
Rodriguez-Merchan, E.C.; Delgado-Martinez, A.D. Current Concepts on the Treatment of Intertrochanteric Fractures to Prevent Nonunion. Preprints 2024, 2024041406. https://doi.org/10.20944/preprints202404.1406.v1
Rodriguez-Merchan, E.C.; Delgado-Martinez, A.D. Current Concepts on the Treatment of Intertrochanteric Fractures to Prevent Nonunion. Preprints2024, 2024041406. https://doi.org/10.20944/preprints202404.1406.v1
APA Style
Rodriguez-Merchan, E.C., & Delgado-Martinez, A.D. (2024). Current Concepts on the Treatment of Intertrochanteric Fractures to Prevent Nonunion. Preprints. https://doi.org/10.20944/preprints202404.1406.v1
Chicago/Turabian Style
Rodriguez-Merchan, E.C. and Alberto D. Delgado-Martinez. 2024 "Current Concepts on the Treatment of Intertrochanteric Fractures to Prevent Nonunion" Preprints. https://doi.org/10.20944/preprints202404.1406.v1
Abstract
Hip fractures are the most frequently treated fractures in the world. Of these, intertrochanteric fractures (ITFs) account for almost 50%. After surgical fixation of ITFs, nonunion is rare. Nonunions are commonly produced from mal-reduction (in varus) and/or inadequate stability of the bone-implant construct and/or fatigue failure of the implants. Other causes of nonunion include posteromedial comminution and osteoporosis. The published incidence of ITF nonunion is 1%-2%. Mechanical complications of ITFs include cut-out, excessive shortening of the proximal femur, delayed union, nonunion, early implant fracture, nail toggle and cut through/medial migration. That is why a fundamental goal in the treatment of ITFs is to achieve stable fixation in osteoporotic bone, allowing early weight bearing. Intraoperative determination of fracture stability is essential. The American Academy of Orthopedic Surgeons (AAOS) clinical practice guidelines for the management of intertrochanteric fractures (ITF) in patients older than 55 years are the following: 1) In patients with stable ITF, the use of either a sliding hip screw (SHS) or a cephalomedullary nail (CMN) is advised (strong strength of evidence). 2) In patients with reverse obliquity fractures, a CMN is recommended (strong strength of evidence). 3) Patients with unstable ITF should be treated with a CMN (strong strength of evidence). 4) In patients with ITF, a short or long CMN may be considered (limited strength of evidence).
Keywords
intertrochanteric fracture; treatment; nonunion; current concepts
Subject
Medicine and Pharmacology, Orthopedics and Sports Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
