This document discusses the treatment of intertrochanteric hip fractures with different fixation devices. It notes that cephalomedullary devices are preferable to dynamic hip screws for fractures with posteromedial comminution or subtrochanteric extension due to their ability to provide controlled collapse and reduce bending forces. The document emphasizes the importance of pre-operative planning, proper reduction techniques, and achieving a tip-apex distance under 25mm for successful fixation with cephalomedullary devices.

1. AND BIOMECHANICS?
*

2. *

5. *
*Posteromedial comminution (calcar)
*Subtrochanteric extension / reverse oblique
*Involvement of lateral cortex

6. *
*Dynamic hip screw (DHS)
*Cephalomedullary device
*Fixed angle device

7. *

8. *

9. *
CONTROLLED
COLLAPSE

10. *

14. *
Shorter lever arm in
CMD – reduce
bending forces

15. *

16. *
*Pre-op planning to determine best way to reduce
the fracture
*Traction
*Internal rotation
*Occasionally need to lift the posterior
displacement

20. *

21. TAD
should be
<25mm

22. *
*Correct indication
*Pre-op planning
*Reduce before scrub
*Slightly inferior - centre
*Achieve TAD <25mm