Title : Rational choice of implants in intertrochanteric fractures in the elderly
Abstract:
Half of all hip fractures in the elderly are around the trochanter and nearly 50% are unstable. The goal of treatment of any intertrochanteric fracture in the elderly is to restore mobility early, safely and efficiently, at the same time minimizing mechanical failure of fixation and narrowing the risk of surgery associated complications. Management in the elderly is challenging because of many compounding factors like poor bone quality, poor compliance and memory, poor patience, poor communicability and poor physical status with multiple co-morbidities. Most of the variables are surgeon independent and at times too demanding for the surgeon. Selecting the appropriate implant and placing it accurately is important to achieve the goal such as to restore the patient back to pre-injury physiological status of mobility and wellbeing. Relevant world literature is reviewed to see various hardware options available and their pros and cons. Author’s experience with some clinical documentation are shared, and discussed. Finally concluded that in elderly various implants can be considered depending upon the particular fracture situation and subjective variables; occasionally the normal hip needs to be sacrificed to give early mobility to the senior.
