[Pertrochanteric fractures].

Pertrochanteric fractures ordinary appear to women 10 to 15 years later than to men. Only 49 per cent of the women and 63 per cent of the men have a good bone structure at that time according to the Singh-index. The classification of pertrochanteric fractures follows the proposal of the AO-ASIF Group. The force which works at the hip joint depends on the function of the limb and is mainly caused by the musculature. This force exceeds up to 4.5 times the body weight. The first 6-24 hours after trauma are the optimal moment for operation. Anaesthesia methods near by the spinal cord should be preferred. The mainly used implant in Germany is the Dynamic Hip Screw (DHS) in more than 60 per cent of cases. Intramedullary implants only reach 15.5 per cent. A fracture table is dispensable for the implantation of a DHS, but the additional fixation of the greater trochanter and in some cases also the lesser trochanter is important. The Gamma Nail is prone to complications caused by the operation. A total hip arthroplasty is performed in about 10 per cent of all pertrochanteric fractures. The AO-document-center can show, that arthroplasty gives very good long-term results. The 130 degrees blade-plate and the Ender-Nail are only used in individual cases. 20 per cent of the patients must have an intensive care follow-up treatment during a medium hospital stay of 29 days, 21 per cent have general non-surgical complications and 8 per cent of the patients die. Nevertheless 78 per cent of all patients can be discharged under partial or full weight-bearing. Scores which allow a comparison of the pre- and postoperative functional status must be applied in order to compare different methods of hip fracture treatment. In a follow-up study 2.7 years after the accident 54 of our own patients had a medium reduction in their functional status of 10 to 15 per cent compared pre- and postoperatively.