Graulich Tilman, Omar Mohamed, Sehmisch Stephan, Liodakis Emmanouil
Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
Department of Trauma, Hand and Reconstructive Surgery, Departments and Institutes of Surgery, Saarland University, 66123 Homburg, Germany.
J Clin Med. 2025 Mar 24;14(7):2200. doi: 10.3390/jcm14072200.
Intertrochanteric fractures become more and more relevant in an aging population. Despite significant progress in the treatment of these fractures, some technical details, concerning the surgical procedure, are still a matter of strong debate. In this review of the literature, we have included the best evidence available from the last decade in an effort to shed light on some of the most controversial subjects related to intertrochanteric fractures: Treatment in the case of polytrauma or monotrauma? Reconstruction or arthroplasty? Open or closed reduction? Reconstruction with or without additional cables and plates? Cephalomedullary nail or dynamic hip screw (DHS)? Long cephalomedullary nail or short cephalomedullary nail? The results of this scoping review are controversial. By introducing a new therapeutic algorithm, we do not intend to present a new finished guideline but rather arouse a controversial debate about a relevant aspect in geriatric traumatology. These conflicting results are an indication that larger and more well-conducted, high-quality trials are needed in order to gain more secure answers.
在老龄化人群中，转子间骨折变得越来越普遍。尽管在这些骨折的治疗方面取得了显著进展，但关于手术过程的一些技术细节仍存在激烈争论。在这篇文献综述中，我们纳入了过去十年中可得的最佳证据，以阐明与转子间骨折相关的一些最具争议的问题：多发伤或单处伤情况下的治疗？重建还是关节置换？切开复位还是闭合复位？使用或不使用额外的缆线和钢板进行重建？髓内钉还是动力髋螺钉（DHS）？长髓内钉还是短髓内钉？本范围综述的结果存在争议。通过引入一种新的治疗算法，我们并非打算提出一个全新的完整指南，而是引发关于老年创伤学中一个相关方面的争议性讨论。这些相互矛盾的结果表明，需要进行更大规模、实施更完善的高质量试验，以便获得更可靠的答案。
