Expandable proximal femoral nails versus 95° dynamic condylar screw-plates for the treatment of reverse oblique intertrochanteric fractures.

The treatment of a simple (AO/OTA classification 31A3.1) reverse oblique intertrochanteric hip fracture is a challenge for the orthopaedic surgeon. The surgical options include the use of side plates with various angled leg screws or intramedullary devices. The purpose of this study was to retrospectively assess our results of treating reverse oblique fracture with an expendable proximal femoral nail (EPFN) or with a dynamic condylar screw-plate (DCS: 95°) between January 2006 and July 2009. Thirty-three patients (6 males and 27 females, mean age 78 years) met the study inclusion criteria and comprised the two study groups: 19 had been treated by EPFNs and 14 had received DCSs. They were followed for a mean of 28 months (range 6-47). Eight patients (5 EPFN and 3 DCS) died during the follow-up period from causes not related to the operation. Two ESPN patients and 5 DCS patients had malunions. Functional outcome scores showed better results in the EPFN group, but the difference was statistically significant only for the sitting subcategory (p=0.04). Based on our results and experience, we propose that the EPFN is at least as good as the DCS for treating reverse oblique fractures of the femur.