This in turn affects the return to full weight-bearing and leads to a significant increase in the rate of complications. Especially in IFFs with unstable fracture patterns (AO/OTA type 31.A2 and A3 or Evans type III, IV, and V), a high degree of comminution, and the presence of low bone quality, it is difficult to obtain an acceptable fracture reduction and a sufficiently stable fixation. However, IF does not always achieve the desired treatment goals. For this purpose, there is a wide variety of extra- or intramedullary devices available on the market. Of the various surgical options, internal fixation (IF) is often the preferred treatment modality. For these reasons, surgical management is the mainstay of treatment for the vast majority of IFFs. In this already fragile population, the aim of the treatment is to achieve a rapid return to the prior functional level with a low rate of complications and mortality. These fractures are often a reason for a reduced quality of life, loss of mobility, increased dependence, and mortality in the year following the injury regardless of the type of treatment. Intertrochanteric femur fractures (IFF) are a major public health problem because of their frequency and the associated complications in older patients. Further studies are needed to identify the intertrochanteric fractures that are at high risk of internal fixation failure, the characteristics that determine which patients may benefit most from hip arthroplasty, and the optimal surgical technique. ![]() ![]() ![]() The literature only offers an overview of the possibilities of the usage of hip arthroplasty, but methodological limitations are common, and evidence levels are low. Currently, there are no guidelines that define the role of hip arthroplasty in the treatment of intertrochanteric femur fractures in older patients. However, the functional outcome and the mortality rate in the longer term tend to favor intramedullary nails, even though the results are inconsistent, and a statistically significant difference cannot always be obtained. Compared with intramedullary nails, hip arthroplasty has a better early functional outcome and lower rates of surgical complications as well as reoperations. Bipolar hemiarthroplasty is the most common type of prosthesis used with primary or revision femoral stems. The choice of the surgical technique mainly depends on the surgeon’s preferences and the fracture characteristics. Especially patients whose condition precludes prolonged bedrest and who are at risk of significant deterioration if their locomotor function cannot be restored rapidly are likely to benefit from hip arthroplasty. Hip arthroplasty is an alternative in older patients with intertrochanteric femur fractures at high risk of fixation failure or with concomitant intraarticular pathologies. Even when treated with intramedullary nails, the overall complication rates are high, especially for unstable or highly comminuted fractures or in the presence of poor bone quality. Surgical management by internal fixation is the mainstay of treatment for most of these fractures. ![]() The treatment aims to achieve a rapid return to the prior functional level with a low rate of complications and mortality. Intertrochanteric femur fractures are common in older patients and often have a significant impact on disability.
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