Tag Archive for: lateral wall

Decision Making in Management of Intertrochanteric Femur Fractures in Adults

/in

Original Article | Vol 12 | Issue 1 | January-June 2026 | page: 49-55 | Sachin Kale, Wasudeo Gadegone, Sushant Srivastav, Nikhil Makhija, Ameey Abhishek, Arpan Mittal

DOI: https://doi.org/10.13107/ti.2026.v12.i01.90

Submitted: 04/03/2023; Reviewed: 27/03/2023; Accepted: 07/05/2023; Published: 10/04/2026

Authors: Sachin Kale [1], Wasudeo Gadegone [1], Sushant Srivastav [1], Nikhil Makhija [1], Ameey Abhishek [1], Arpan Mittal [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

[2] Gadegone Hospital, Chandrapur, Maharashtra, India.

Address of Correspondence

Dr. Sachin Kale

Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India.

E-mail: sachinkale@gmail.com

Abstract

Intertrochanteric femur fractures are among the most common proximal femoral injuries, particularly in the elderly with osteoporosis. They are associated with significant morbidity, mortality, and loss of independence. Although these fractures generally have good vascularity and low nonunion rates, their inherent mechanical instability demands precise assessment of stability and individualized implant selection. This chapter provides a clinically oriented review of anatomy, biomechanics, classification, radiological evaluation, and evidence-based management strategies. Fracture stability—guided primarily by the integrity of the posteromedial cortex, lateral wall, and overall pattern—remains the cornerstone of decision-making. Stable fractures (AO/OTA 31-A1) are reliably managed with a sliding hip screw (DHS), while unstable patterns (most 31-A2 and all 31-A3) are best treated with cephalomedullary nails (e.g., PFNA or equivalent) due to their superior biomechanical stability and load-sharing properties. The integrity of the lateral wall plays a critical role in determining implant choice, as its compromise significantly increases the risk of fixation failure with extramedullary devices. Achieving proper reduction, particularly avoiding varus malalignment, is essential to prevent complications. Early surgical intervention and mobilization are key factors in reducing systemic complications such as deep vein thrombosis and pulmonary complications. In India, intertrochanteric fractures predominate among proximal femoral injuries, often with delayed presentation. Osteoporosis (Singh’s index), domestic falls, and comorbidities (hypertension, diabetes) are common. Early surgery (ideally within 48 hours when medically optimized), multidisciplinary care, and rehabilitation remain challenges but are essential for improving functional recovery and reducing mortality. Early surgical fixation and mobilization, within a multidisciplinary framework, are critical to optimizing outcomes. Individualized treatment planning, meticulous surgical technique, and early mobilization remain the cornerstones of achieving favorable functional outcomes, particularly in the elderly population.

Keywords: Intertrochanteric fracture, proximal femoral nail, dynamic hip screw, fracture stability, lateral wall, cephalomedullary nailing

References

  1. Rockwood CA, Green DP, Bucholz RW, Heckman JD, Tornetta P. Rockwood and Green’s Fractures in Adults. 9th ed. Philadelphia: Wolters Kluwer; 2020.
  2. Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P. Trauma. 9th ed. Philadelphia: Elsevier; 2020.
  3. Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London: Elsevier; 2020.
  4. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res. 1980;(146):53–61.
  5. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium—2018. J Orthop Trauma. 2018;32(Suppl 1):S1–S170.
  6. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949;31B(2):190–203.
  7. Rubin G, Peleg K, Givon A, Rozen N. Imaging modalities in hip fractures. Injury. 2015;46(6):S24–S27.
  8. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation. J Bone Joint Surg Am. 1995;77(7):1058–1064.
  9. Parker MJ, Handoll HH. Intramedullary nails for extracapsular hip fractures. Cochrane Database Syst Rev. 2006;(3):CD004961.
  10. Strauss EJ, Frank J, Lee J, Kummer FJ, Tejwani NC. Helical blade versus lag screw fixation. J Orthop Trauma. 2006;20(9):599–605.
  11. Gotfried Y. The lateral trochanteric wall: a key element in stability. Clin Orthop Relat Res. 2004;(425):82–86.
How to Cite this article: Kale S, Gadegone W, Srivastav S, Makhija N, Abhishek A, Mittal A. Decision Making in Management of Intertrochanteric Femur Fractures in Adults. | January-June 2026; 12(1): 49-55 | https://doi.org/10.13107/ti.2026.v12.i01.90

 

(Abstract Text HTML)   (Download PDF)