title: Fractures of the proximal part of the femur.
abstract: The orthopaedic surgeon has a multitude of internal fixation devices and techniques available for use in the treatment of subtrochanteric fractures of the proximal femur. The successful use of second-generation locking nails is technically demanding. Close attention to positioning of the patient, reduction of the fracture, placement of the guide-wire, and insertion of the nail and of the proximal and distal locking screws is mandatory. The newer, high-strength hip-screws allow good fixation of a fracture that extends into the piriformis fossa. If medial comminution is present, this technique is best performed in conjunction with indirect reduction and bone-grafting. With proper technique, these devices allow the surgeon to manage predictably a complex subtrochanteric fracture that previously had to be treated with traction or extensive dissection and with (frequently inadequate) internal fixation.
authors.affiliation: Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Kyle
authors.forename: M E
authors.initials: ME
authors.lastname: Cabanela
authors.forename: T A
authors.initials: TA
authors.lastname: Russell
authors.forename: M F
authors.initials: MF
authors.lastname: Swiontkowski
authors.forename: R A
authors.initials: RA
authors.lastname: Winquist
authors.forename: J D
authors.initials: JD
authors.lastname: Zuckerman
authors.forename: A H
authors.initials: AH
authors.lastname: Schmidt
authors.forename: K J
authors.initials: KJ
authors.lastname: Koval
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000033:anatomy & histology; D005271:Femur Head Necrosis / Q000209:etiology; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D005599:Fractures, Ununited / Q000209:etiology; D006620:Hip Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography