This 2004 JAAOS review by Lindskog and Baumgaertner addresses the evaluation, classification, and surgical management of unstable intertrochanteric hip fractures in elderly patients — specifically examining when standard compression hip screw fixation is insufficient and which alternative implant strategies should be used instead.
When you see a reverse oblique or intertrochanteric-subtrochanteric fracture (OTA class A3), don't use a standard compression hip screw — the fracture line runs parallel to the screw's sliding direction, allowing uncontrolled medialization; choose an intramedullary hip screw or axial compression plate instead.
For any intertrochanteric fixation, aim for TAD <25 mm (dead center, very deep on both AP and lateral). This single technical variable is your most controllable predictor of avoiding cutout.
This 2004 JAAOS review by Lindskog and Baumgaertner addresses the evaluation, classification, and surgical management of unstable intertrochanteric hip fractures in elderly patients — specifically examining when standard compression hip screw fixation is insufficient and which alternative implant strategies should be used instead.
When you see a reverse oblique or intertrochanteric-subtrochanteric fracture (OTA class A3), don't use a standard compression hip screw — the fracture line runs parallel to the screw's sliding direction, allowing uncontrolled medialization; choose an intramedullary hip screw or axial compression plate instead.
For any intertrochanteric fixation, aim for TAD <25 mm (dead center, very deep on both AP and lateral). This single technical variable is your most controllable predictor of avoiding cutout.