Short or Long, Locked or Unlocked Nails for Intertrochanteric Fractures

Intramedullary implant has emerged as the workhorse in the management of intertrochanteric fracture, especially unstable intertrochanteric in recent times. A number of factors including fracture specific such as stable or unstable, integrity of greater trochanter, and lateral buttress, and patient specific such as osteoporosis, medical comorbidities, and preinjury ambulation status have to be considered in detail, to have a favorable outcome. Disagreements exist pertaining to differences in nail length (short or long), proximal head-neck fixation methods (lag screws or helical blade), need for distal fixation (locked or unlocked), nail diameter, and radius of curvature for long nails. In this article, management strategies are provided to aid the treating surgeon in making an appropriate decision in view of the influencing factors. The standard technique to be followed while nailing is described, as also the additional steps that have to be taken in particular circumstances are defined. A comprehensive literature review is provided comparing the evidence for current practice in managing these fractures.