الفهرس 
Risk factors and classificationOnly 14 pages are availabe for public view
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Abstract
Operative management is the treatment of choice for the vast majority of
intertrochanteric fractures, as it allows early rehabilitation and offers the patient the best
chance for functional recovery. Rigid internal fixation and early mobilization are the key points
of the treatment. Stable intertrochanteric fractures can be easily treated by osteosynthesis with
predictable good results, whereas the management of unstable intertrochantric fractures is
challenging because of poor bone quality, osteoporosis and other underlying diseases. Although
there are some fixation methods such as sliding hip screw and intramedullary interlocking
devices, no one guarantees absolute fracture stability and complete bone union in elderly patients.
Unstable fracture patterns comprise those with comminution of the posteromedial cortex,
subtrochanteric extension, or a reverse obliquity pattern.
The goal of operative treatment is strong, stable fixation of the fracture fragments.The sliding
compression device, a widely used implant in unstable proximal femoral fractures, suffers from two
major limitations: excessive collapse and screw cut-out. Commonly attributed reasons for these are
lateral wall comminution and single-point fixation, respectively.Osteoporosis and instability are
two of the most important factors leading to unsatisfactory results of treatment, and in the
elderly the coexistence of unstable, comminuted fractures with osteoporosis worsens the prognosis.
The intramedullary fixation using proximal femoral nail is highly accepted option as fixation
device.Due to high failure rate and complications associated with internal fixation, prosthetic
replacement has been recommended by some authors as primary treatment for
unstable
intertrochanteric fractures as it provides the individual with greatest opportunity for early
ambulation. In the patient with preexisting symptomatic degenerative arthritis, primary prosthetic
replacement may be the best option. It can also be considered for intertrochanteric fractures with
extreme comminution in severely osteoporotic bone in which internal fixation methods are unlikely
to be successful.
Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable
option that can prevent the complications of an open reduction, such as nonunion and metal
failureand significantly reduced the incidence of various post- operative complications associated
with prolonged immobilization like venous thrombosis, pressure sores and pulmonary complications
etc.There have been various reports of successful outcomes after the use of hemiarthroplasty and
total hip arthroplasty (THA). This technique allows early ambulation, bearing weight immediately
and encourages the patient to move and exercise the involved limbs, thus avoids recumbency and its
associated complications. The increased blood loss, mechanical complications like dislocation and
the need for calcar replacement are possible complications for arthroplasty.
The decision to perform a hemiarthroplasty or a total hip arthroplasty is based on functional
demands of the patient and the condition of the acetabular articular cartilage.However, an ideal
treatment method is still rather debated because of the poor quality of bone mass, comorbid
disorders, and difficulty in rehabilitation of these patients.