Treatment methods for proximal femur fractures generally fall into 2 categories: nails and plates. These devices include a large lag screw designed to capture and control the head neck fragment and are connected to the shaft by means of a side plate or intramedullary nail (IMN). The common mechanism of action is a controlled impaction of the fracture to allow metaphyseal healing while maintaining anatomic alignment. The sliding hip screw (SHS) side plate construct has been in use since the early 1950s,1,2 and is considered the “gold standard” for treatment of pertrochanteric hip fractures. It is by far the most widely used surgical implant for fixing these fractures as well.3 Recently, an iatrogenic fracture of the lateral wall of the trochanter has been described as a surgical complication,4,5 confirmed by additional studies6,7 and, although thought to occur primarily when using plate constructs, can occur with IMN fixation as well.4–7 Because of the unique nature of this operative as well as post operative problem, the author has previously considered and described this as a separate entity, the pantrochanteric fracture.8 Understanding this additional fracture entity is critical for proper treatment of a variety of pertrochanteric hip fractures.

Fracture classifications are initially designed to indicate the severity of a fracture. In the OTA classification, a pertrochanteric hip fracture is designated as a 31A fracture.9 While a 31.A1 represents a simple stable fracture with only 2 fragments, the 31-A2 indicates a comminuted fracture. Within the A2 group, although severe medial comminution may occur, the classification always assumes an intact lateral trochanteric wall. The 31-A3 represents a fracture that can be either a reverse obliquity fracture or a transverse high subtrochanteric fracture.9 In all cases, an associated lateral wall fracture is shown as a dotted line. Although the lateral wall is a part of the trochanteric region, it is also the most proximal extension of the femoral shaft. The lateral wall, as we now know, is essential for a stable osteosynthesis because it acts as the lateral buttress, without which both fracture healing and muscle function are compromised.5