Surgical Management of Pertrochanteric Fractures

Fracture Classification and Implant Selection

The American Academy of Orthopaedic Surgeons recommends that for unstable pertrochanteric fractures, cephalomedullary nail fixation should be used, while stable intertrochanteric fractures can be treated with either a sliding hip screw or cephalomedullary nail 1, 2, 3
For stable intertrochanteric fractures, either a sliding hip screw or a cephalomedullary device is recommended, with strong evidence and a strong recommendation 3
Both sliding hip screw and cephalomedullary device provide equivalent outcomes for simple two-part fractures without significant comminution, according to the American Academy of Orthopaedic Surgeons 4

The American Academy of Orthopaedic Surgeons recommends that either spinal or general anesthesia is appropriate, with a strong recommendation 3
Tranexamic acid should be administered to reduce blood loss and transfusion requirements, with strong evidence and a strong recommendation, as suggested by the American Academy of Orthopaedic Surgeons 1, 3
Multimodal analgesia incorporating a preoperative nerve block is recommended, with strong evidence and a strong recommendation, according to the American Academy of Orthopaedic Surgeons 1, 2, 3

All patients should undergo evaluation and treatment for osteoporosis, with strong evidence and a strong recommendation, as suggested by the American Academy of Orthopaedic Surgeons 1, 2
The American Academy of Orthopaedic Surgeons recommends ordering outpatient DEXA scan and measuring vitamin D, calcium, and parathyroid hormone levels during hospitalization 1, 2

Interdisciplinary care programs should be used to decrease complications and improve outcomes, with a strong recommendation, according to the American Academy of Orthopaedic Surgeons 3

The American Academy of Orthopaedic Surgeons recommends not using preoperative traction for hip fracture patients, with strong evidence and a strong recommendation 1, 2