Instr Course Lect. 2023;72:319-339.
Successful management of extracapsular hip fractures requires a comprehensive understanding of fracture stability to optimize outcomes and help prevent mechanical failures. Currently, the definition of stability is imperfect, as demonstrated by continued failure and moderate-to-severe collapse observed in stable fractures. Adopting a more three-dimensional approach has led to a greater understanding of the role of rotational instability in mechanical failures, and torsion control devices are now becoming more readily available as part of the most recent generation of cephalomedullary nails. Although new technology can be useful when used appropriately, new products alone are neither able to completely eliminate failures nor do they obviate the need for a good reduction or good surgical technique. The management of complications following extracapsular hip fracture fixation now involves a more inclusive definition of failure to address the loss of independence reflected in the functional outcomes associated with these injuries. In the presence of combined radiographic and clinical failure, early revision surgery can immediately improve mobility and outcome.
成功治疗髋关节囊外骨折需要全面了解骨折稳定性，以优化治疗效果并预防机械失败。目前，稳定性的定义并不完善，因为在稳定骨折中仍观察到持续失败和中重度塌陷。采用更三维的方法可以更好地理解旋转不稳定在机械失败中的作用，现在扭力控制装置作为最新一代股骨近端髓内钉的一部分，越来越容易获得。尽管新技术在适当使用时可能有用，但新产品本身既不能完全消除失败，也不能免除良好复位或良好手术技术的需求。髋关节囊外骨折固定后的并发症处理现在涉及更全面的失败定义，以解决与这些损伤相关的功能结果所反映的独立性丧失。在出现放射影像学和临床综合失败的情况下，早期翻修手术可以立即提高活动能力和治疗效果。
