Hip Fracture - Extracapsular Subtrochanteric Fractures

These fractures are associated with increased blood loss and increased risk of pathologic origin. They are generally treated with intramedullary devices or sliding hip screws with long side plates. Intramedullary devices are rods that insert through the canal of the bone and have interlocking screws that pass through both sides of the bone and the rod to stabilize the fracture. In the case of pathologic fracture, the surgeon may choose to utilize methyl methacrylate (bone cement) and/or prosthetic replacement to enhance stabilization.

As bone becomes more osteoporotic, fracture patterns can become more complex and extracapsular Figure 3. Displaced unstable intertrochanteric fracture fixed with hip compression screw (DHS: Dynamic Hip Screw, synthesis). (X-ray provided by P. Rockwood.) fractures can consist of intertrochanteric fractures with subtrochanteric extension. These fractures can be very unstable and technically challenging to fix. The specific choice of implant will vary from surgeon to surgeon and center to center. Since their introduction, cephalomedullary interlocking femoral nails have been utilized as an intramedullary nail, with screws that lock into the femoral head through the nail. The hardware is also locked with screws distally in the nail through the bone. These devices have been successful in treating such complex fracture patterns.