Unstable intertrochanteric/subtrochanteric fractures of the femur.

The unstable intertrochanteric/subtrochanteric fracture, as identified by the modified Müller classification, should be considered a separate entity with its own problems. It can be highly unstable; none of the orthopedic appliances has been designed with this fracture in mind. Compression screws yield better results than Enders rods in these fractures. However, eight patients (16%) in this study who were treated with a compression screw did have a complication. Thus, further studies need to be done to develop other orthopedic appliances for these unstable fractures. Enders rods and compression screws were used to treat 72 unstable intertrochanteric/subtrochanteric fractures. The type of surgical procedure was determined by the surgeon. Anesthesia time and blood loss were significantly lower in the group treated with the Enders nail. Intraoperative and postoperative complications of the Enders group were reported in four (20%) and eight patients (32%), respectively, as compared to zero and eight patients (16%) in the compression screw group. Postoperative time to ambulation, knee pain, and reoperation rate were significantly higher in those treated with the Enders nail. Fracture reduction and ideal device position were acceptable in only 16 patients (64%) and four patients (16%) of the Enders group, respectively, compared with 46 patients (98%) and 40 patients (86%) in the compression screw group.