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 failure and 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.