Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation.

One hundred sixty-two cases of unstable intertrochanteric fractures treated by anatomic reduction and compression hip screw fixation were reviewed. One hundred twenty-four of these patients were followed up for an average of 19.2 months. Loss of fixation, with varus angulation of the fracture, occurred in five patients, a 4% incidence of failure. One hundred ten patients were bearing full weight an average of three weeks after operation. Fracture healing occurred an average of 18 weeks after operation. After compression was applied, 90% of the fractures moved into medial displacement position. Eight percent of the fractures laterally displaced; 2% of the fractures maintained their anatomic alignment. Nonanatomic reduction, e.g., stable reduction accomplished by displacement osteotomy (after Dimon and Hughston), has no advantage over anatomic reduction and fixation by a compression hip screw. The advantages of the latter technique are that weight-bearing can be started early, the device can be used for stable and unstable intertrochanteric fractures with identical technique, and fixation is rigid and allows for compression of the fracture site, while maintaining alignment.