Geriatric Femur Fractures: Implant Choice in Pertrochanteric Hip Fractures

Geriatric hip fractures are a common problem facing orthopedic surgeons on call in the community. This review discusses pertrochanteric fractures and the surgeon-controlled variables related to their operative treatment. The reduction of these fractures relies on the restoration of the calcar. Implants most often used for pertrochanteric fractures consist of either intramedullary versus extramedullary constructs. The lateral wall integrity and intact thickness is used to determine fixation strategies. Intramedullary devices have been shown to be biomechanically superior, and able to be used across a larger spectrum of fractures. However, their versatility comes with increasing cost. The length of the nail remains controversial, but the chance of a peri-implant fracture or complication appears to be similar amongst all lengths, including the “intermediate” length devices. Different types of fixation into the head have also been studied with helical blades versus screws both demonstrating unique failure types. Several head fixation augmentations and strategies have been described as well, each with their own advantages and disadvantages. Regardless of implant choice, tip-to-apex remains one of the more important factors in limiting failure.