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Use of a long intramedullary device
1%
12/1184
Use of a short intramedullary device
6%
66/1184
Use of external fixation
2%
28/1184
Postoperative weight bearing status
67/1184
Intraoperative fracture of the lateral femoral wall
85%
1008/1184
Select Answer to see Preferred Response
Intertrochanteric hip fractures with lateral wall fractures should be treated with an intramedullary device as opposed to a sliding hip screw, as the intact lateral wall provides a buttress for the proximal fragment facilitating fracture impaction as well as rotational and varus stability. Palm et al showed that 22% of patients with a fractured lateral femoral wall underwent reoperation for collapse of fracture compared to 3% with an intact lateral femoral wall. Interestingly, 74% of the lateral proximal femoral wall fractures were iatrogenic during the procedure itself. Gotfried et al reported on 24 patients with postoperative intertrochanteric hip fracture collapse and noted that this complication followed fracture of the lateral wall in every instance and resulted in a protracted period of disability until fracture healing. They recommend care when drilling at the base of the lateral wall intraoperatively. Lindskog et al review the diagnosis, treatment, as well as biomechanical reviews of treatment options for unstable intertrochanteric hip fractures. Incorrect Answers: Answer 1, 2, and 3: No difference in collapse has been shown between long or short intramedullary devices and an external fixator in stable intertrochanteric hip fractures. Answer 4: Early postoperative weightbearing is the goal after repair, and no differences have been shown in collapse rates with different weight bearing protocols.
3.6
(33)
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