Intertrochanteric fractures. The role of complications of fixation.

A review was made of 244 intertrochanteric fractures of the hip. The complications of fixation were examined; nail penetration, plate separation, or bending or breaking of the device. Factors associated with fewer such complications were (1) stable (noncomminuted) fractures, (2) nails that can accomodate to varus, (3) placement of the nail tip more than 10 mm from the subchondral cortex of the femoral head, (4) valgus reduction of the fracture, and (5) high osteoporosis grade (denoting less osteoporosis). Neither medial displacement osteotomy nor exact anatomic reduction of unstable fractures improved resuts. In most patients, complications of fixation did not adversely influence the clinical course measured in terms of altered walking capacity, need for secondary surgery, or residual hip pain.