5th Orthopaedic Department, KAT Hospital, Nikis 2 Street, Kifissia, Athens 145 61, Greece.
Injury. 2012 Jun;43(6):686-93. doi: 10.1016/j.injury.2011.05.031. Epub 2011 Jul 14.
Intramedullary nailing is gradually emerging as the treatment of choice for pertrochanteric femoral fractures. Nevertheless, prospective randomised trials have failed to demonstrate the assumed superiority of cephalomedullary nails over the traditional treatment with the sliding hip screw. On the contrary, the gamma nail has been implicated in predisposing to secondary femoral fractures, although this seems to be rectified by newer techniques and nail designs. Sliding hip screw fixation remains the gold standard but can lead certain unstable pertrochanteric fracture subgroups to failure. Amongst these are transverse or reverse obliquity but also multifragmentary fractures, that suffer intra- or postoperative shattering of the lateral trochanteric wall. Nails seem to prevent failure by opposing the uncontrollable medialisation, and eventual failure, that occurs under these circumstances. The importance of the size of the proximal fracture fragment has not yet been elucidated. Nail fixation is, thus, mandatory in a small percentage of grossly unstable fractures, whose characteristics are still undergoing definition.
髓内钉逐渐成为股骨转子间骨折的首选治疗方法。然而，前瞻性随机试验未能证明顺行髓内钉比传统的滑动髋螺钉治疗具有优势。相反，伽玛钉被认为容易导致继发性股骨干骨折，尽管这似乎可以通过新技术和钉设计来纠正。滑动髋螺钉固定仍然是金标准，但某些不稳定的转子间骨折亚组可能会导致失败。其中包括横断或反斜形骨折，但也有多段骨折，在术中或术后外侧转子骨壁会碎裂。髓内钉通过抵抗在这些情况下发生的不可控制的内侧移位和最终的失效来防止失败。近端骨折块大小的重要性尚未阐明。因此，在一小部分严重不稳定骨折中必须使用髓内钉固定，这些骨折的特征仍在定义中。
