Actualización del tratamiento de las fracturas intertrocantéricas

Intertrochanteric fractures represent 50% of all proximal femur fractures and their incidence is increasing due to the greater life expectancy of the population. Reduction and fixation with a proximal femoral nail is the treatment of choice. However, the failure of osteosynthesis generates an increase in morbidity and mortality, especially elderly patients. Numerous studies indicate that main factors of failure are related to errors in fracture reduction and incorrect implant placement. These errors can occur at different steps of the surgical technique: preoperative planning, patient positioning, visualization and reduction of the fracture; location of the entry point and positioning of the cephalic element (screw or plate). Therefore, based on the existing literature and the experience of more than 1000 intertrochanteric fractures treated with proximal femoral nails from April 2002 to May 2020, we set to describe possible errors during the surgical technique and provide a systematic guide to avoid them. Conclusion: Despite implant design improvements in recent years, the main factors that determine the final result of the fixation of intertrochanteric fractures are thequality of reduction and the correct positioning of the implant. Awareness of the different errors that may occur at each step of the surgical technique is essential to avoid them.