The document discusses geriatric hip fractures, focusing on the types (stable vs unstable) and respective treatment options. It highlights the features of unstable fractures, particularly the trochanteric and subtrochanteric types, and compares different surgical methods, namely Dynamic Hip Screw (DHS) and Cannulated Mean Nail (CMN). Recommendations suggest CMN for unstable fractures due to its advantages in reducing complications and improving functional outcomes.

1. Geriatric Hip Fracture
Muhammad Azrin Mohd Asihin

2. Content
1. Type of fracture
2. Stable vs unstable
3. Treatment options

3. Area of fracture

4. Trochanteric fracture
3 = Femur
1 = Proximal
A = Trochanteric
31B 31C
AO/OTA Fracture and Dislocation Classification

5. Features of unstable fracture
i. Loss of calcar buttress / posteromedial comminution
ii. Thin (< 2cm) / comminution lateral wall
iii. Reverse obliquity fracture
iv. Subtrochanteric extension
ii
i
iii

6. Lateral wall measurement

7. 1 2 3
Simple Multifragmentary
(lateral wall < 20.5mm)
Reverse oblique /
intertrochanteric
31A

8. Stable pattern (31A1)
Lateral wall intact (>20.5 mm) fracture
31A1.3

9. Unstable pattern (31A2)

10. Unstable pattern (31A3)

11. Treatment options
DHS CMN

12. DHS
• Stable / simple fracture only
• Controlled collapse

13. DHS vs CMN for 31A2 & 31A3
• CMN has
• Lower blood loss
• Shorter operative time
• Lower fixation failure
• Less superficial infection
• Less non union
• Better functional score
• CMN for 31A1?

14. DHS vs CMN for Subtrochanteric fracture?
• CMN has
• Lower fixation failure
• Lower revision rate
• Lower non union rate
• Cerclage wire?
• Better functional outcome
• Shorter hosp stay
• Better reduction
• Shorter time to union

15. Recommendation of treatment
Stable  DHS / CMN
Unstable  CMN

16. Recommendation of treatment
Subtrochanteric fracture = Unstable fracture
Unstable fracture  CMN

18. CMN
• Shorter moment arm
• Unstable #
• IM buttress
• Prevent rotation
• Maintain head offset
Buttress effect

19. Thank you