Intertrochanteric Fractures

Think mechanically:

• Stable — intact posteromedial buttress; controlled collapse acceptable
• Unstable — reverse obliquity, large posteromedial fragment, subtrochanteric extension, lateral wall incompetence

AO/OTA typing helps documentation; instability features change the implant.

If the pattern will collapse into varus or shaft medialization under a screw-sideplate alone, choose a nail (or another construct that controls that failure mode). Medical optimization and early surgery still dominate outcomes in the elderly.

Do not confuse a femoral neck fracture with an intertrochanteric pattern on a tired AP — the operation is different.

• Sliding hip screw for many stable patterns
• Cephalomedullary nailing for unstable patterns and many reverse obliquity injuries
• Tip-apex distance and reduction quality still decide failure after fixation
• Mobilize early; treat this as a fragility fracture system problem

• Extracapsular — different biology than femoral neck
• Unstable patterns → nail thinking
• Tip-apex distance matters
• Reverse obliquity is a classic unstable pattern