Evidence-based narrative review of level I–III studies examining surgical management of intertrochanteric hip fractures. Addresses whether IM nails or extramedullary devices (DHS/SHS) produce better outcomes across stable and unstable fracture patterns, and when arthroplasty is appropriate.
When you see an unstable intertrochanteric fracture (reverse obliquity, posteromedial comminution, or subtrochanteric extension), favor an IM device — but counsel that the evidence base supports faster mobilization and less blood loss rather than proven superiority in functional outcome.
For stable patterns, either DHS or IM nail is defensible; let surgeon familiarity and implant cost guide the decision.
Evidence-based narrative review of level I–III studies examining surgical management of intertrochanteric hip fractures. Addresses whether IM nails or extramedullary devices (DHS/SHS) produce better outcomes across stable and unstable fracture patterns, and when arthroplasty is appropriate.
When you see an unstable intertrochanteric fracture (reverse obliquity, posteromedial comminution, or subtrochanteric extension), favor an IM device — but counsel that the evidence base supports faster mobilization and less blood loss rather than proven superiority in functional outcome.
For stable patterns, either DHS or IM nail is defensible; let surgeon familiarity and implant cost guide the decision.