Paper| Volume 26, ISSUE 9, P611-614, November 1995

How to minimize failures of fixation of unstable intertrochanteric fractures

      This paper is only available as a PDF. To read, Please Download here.


      Sliding hip screws have improved the treatment of unstable intertrochanteric hip fractures and their success, compared with fixed devices, is in large part due to the sharing of load between the implant and the fracture fragments. In a prospective study of 100 patients with such fractures, five factors concerned with the fracture and its fixation were studied and odds ratios calculated of their relative importance in prediction of failure. The most important factor affecting the load borne by the fracture fragments was the amount of slide available within the device, and that affecting the load carried by the device was the position of the screw in the femoral head. For fractures fixed with a device allowing less than 10 mm of slide, and those with superior screw position, the risk of failure was increased by factors of 3.2 and 5.9, respectively. Anatomical reduction alone, rather than osteotomy, together with sliding hip screw fixation, has been recommended for these fractures in three prospective randomized trials. It is calculated here that to allow sufficient slide when employing this technique, it is essential to use a short barrel device when using dynamic screws of 85 mm or less. This has not been demonstrated before.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bannister GC
        • Gibson AGF
        Jewett nail-plate or AO dynamic hip screw for trochanteric fractures? A randomized prospective controlled trial.
        J Bone Joint Surg. 1983; 65B: 218
        • Esser MP
        • Kassab JY
        • Jones DHA
        Trochanteric fractures of the femur: a randomized prospective trial comparing the Jewett nail-plate with the dynamic hip screw.
        J Bone Joint Surg. 1986; 68B: 557
        • Heyse-Moore GH
        • MacEahern AG
        • Jameson Evans DC
        Treatment of intertrochanteric fractures of the femur: a comparison of the Richards screw-plate with the Jewett nail-plate.
        J Bone Joint Surg. 1983; 65B: 262
        • Davis TRC
        • Sher JL
        • Horsman A
        • et al.
        Intertrochanteric femoral fractures: mechanical failure after internal fixation.
        J Bone Joint Surg. 1990; 72B: 26
        • Den Hartog BD
        • Bartal E
        • Cooke F
        Treatment of the unstable intertrochanteric fracture: effect of the placement of the screw, its angle of insertion, and osteotomy.
        J Bone Joint Surg. 1991; 73A: 726
        • Mulholland RC
        • Gunn DR
        Sliding screw plate fixation of intertrochanteric femoral fractures.
        J Trauma. 1972; 12: 581
        • Dunn D
        Sliding hip screws and medial displacement osteotomy.
        J R Soc Med. 1988; 81: 140
        • Thomas AP
        Dynamic hip screws that fail.
        Injury. 1991; 22: 46
        • Mainds CC
        • Newman RJ
        Implant failures in patients with proximal fractures of the femur treated with a sliding screw device.
        Injury. 1989; 20: 98
        • Laskin RS
        • Gruber MA
        • Zimmerman AJ
        Intertrochanteric fractures of the hip in the elderly: a retrospective analysis of 236 cases.
        Clin Orthop. 1979; 141: 188
        • Kyle RF
        • Gustilo RB
        • Premer RF
        Analysis of six hundred and twenty-two intertrochanteric hip fractures: a retrospective and prospective study.
        J Bone Joint Surg. 1979; 61A: 216
        • Laros GS
        • Moore JF
        Complications of fixation in intertrochanteric fractures.
        Clin Orthop. 1974; 101: 110
        • Jensen JS
        • Sonne-Holm S
        • Tøndevold E
        Unstable trochanteric fractures: a comparative analysis of four methods of internal fixation.
        Acta Orthop Scand. 1980; 51: 949
        • Sarmiento A
        • Williams EM
        The unstable intertrochanteric fracture: treatment with a valgus osteotomy and l-bearn nail plate.
        J Bone Joint Surg. 1970; 52A: 1309
        • Dimon III, JH
        • Hughston JC
        Unstable intertrochanteric fractures of the hip.
        J Bone Joint Surg. 1967; 49A: 440
        • Clark DW
        • Ribbans WJ
        Treatment of unstable intertrochanteric fractures of the femur: a prospective trial comparing anatomical reduction and valgus osteotomy.
        Injury. 1990; 21: 84
        • Desjardins AL
        • Roy A
        • Paiement G
        • et al.
        Unstable intertrochanteric fracture of the femur: a prospective randomized study comparing anatomical reduction and medial displacement osteotomy.
        J Bone Joint Surg. 1993; 75B: 445
        • Gargan MF
        • Gundle R
        • Simpson AHRW
        How effective are osteotomies for unstable intertrochanteric fractures?.
        J Bone Joint Surg. 1994; 76B: 789
        • Evans EM
        The treatment of trochanteric fractures of the femur.
        J Bone Joint Surg. 1949; 31B: 190
        • Singh M
        • Nagrath AR
        • Maini PS
        Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis.
        J Bone Joint Surg. 1970; 52A: 457
        • Raaymakers ELFB
        • Marti RK
        Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases.
        J Bone Joint Surg. 1991; 73B: 950
        • DeLee JC
        Fractures and dislocations of the hip.
        in: 3rd Edn. Fractures in Adults. Vol 2. Lippincott, Philadelphia1991: 1538
        • Simpson AHRW
        • Varty K
        • Dodd CAF
        Sliding hip screws: modes of failure.
        Injury. 1989; 20: 227