[Therapeutic possibilities in trochanteric fractures. Safe--fast--stable]

Abstract

Trochanteric fractures frequently occur in elder patients with severe osteopenia. These fractures are highly unstable. Conservative treatment is not indicated because of the long period of immobilization until fracture healing is achieved. Simple fractures (A1) can be successfully fixed by either plate-hip screw systems like Dynamic Hip Screw (DHS) or nail-hip screw systems (Gamma-Nail, Proximal Femur Nail, Classic Nail). As a result of biomechanical and clinical trials the intramedullary implants should be preferred for fixation of more comminuted fractures (Type A2.2, A3.3) and subtrochanteric fractures. For ipsilateral femoral shaft and trochanteric fractures long nail-hip screw-systems are recommended like the long PFN or the long Gamma nail. In about 90% of the patients with trochanteric fractures postoperative weight bearing can be achieved by internal fixation if gliding systems are applied. Intraoperative and postoperative complications however occur more frequently after the implantation of Gamma-Nail than after application of a DHS. Other implants like Ender Nails, 130 degrees angled plate or twisted plate are not further recommended.