Second-generation cephalomedullary nails in the treatment of reverse obliquity intertrochanteric fractures of the proximal femur.

Since 1996, in Tampere University Hospital, a second-generation cephalomedullary nail (CMN) has been the implant of first choice in reverse obliquity fractures of the proximal femur. Between 1996 and 1999 we treated 77 such fractures, of which 72 were fixed with the CMN. There were six re-operations (8.3%). An anatomic or nearly anatomic reduction and a properly placed implant were found in 47 cases with one failure. An unacceptable postoperative radiological result was seen in 25 cases resulting in five re-operations (P=0.029). In 12 of 14 open procedures a cable was added to stabilise the greater trochanter and none failed. Four of five fractures fixed with the sliding hip screw failed. Our results using the CMN in reverse obliquity intertrochanteric fractures compares favourably to the results in earlier reports where extramedullary implants are used.