Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations

Bone Joint J. 2017 Jan;99-B(1):128-133. doi: 10.1302/0301-620X.99B1.BJJ-2016-0134.R1.


Aims: The aim of this paper is to review the evidence relating to the anatomy of the proximal femur, the geometry of the fracture and the characteristics of implants and methods of fixation of intertrochanteric fractures of the hip.

Materials and methods: Relevant papers were identified from appropriate clinical databases and a narrative review was undertaken.

Results: Stable, unstable, and subtrochanteric intertrochanteric fractures vary widely in their anatomical and biomechanical characteristics, as do the implants used for their fixation. The optimal choice of implant addresses the stability of the fracture and affects the outcome.

Conclusion: The treatment of intertrochanteric fractures of the hip has evolved along with changes in the design of the implants used to fix them, but there remains conflicting evidence to guide the choice of implant. We advocate fixation of 31A1 fractures with a sliding hip screw and all others with an intramedullary device. Cite this article: Bone Joint J 2017;99-B:128-33.

Keywords: Hip fracture; Intertrochanteric; Pertrochanteric.

Publication types

  • Review

MeSH terms

  • Bone Nails / economics
  • Bone Nails / standards
  • Bone Plates / economics
  • Bone Plates / standards*
  • Bone Screws / economics
  • Bone Screws / standards*
  • Bone-Implant Interface
  • Cost-Benefit Analysis
  • Fracture Fixation, Intramedullary / economics
  • Fracture Fixation, Intramedullary / instrumentation*
  • Hip Fractures / economics
  • Hip Fractures / surgery*
  • Humans
  • Periprosthetic Fractures / etiology
  • Prosthesis Design / economics
  • Prosthesis Design / standards
  • Randomized Controlled Trials as Topic