A cephalomedullary nail (PFNA or Gamma nail) is preferred over a sliding hip screw (DHS) for which intertrochanteric fracture pattern? Select the MOST specific indication.
- A Stable two-part intertrochanteric fracture with intact posteromedial cortex in a 75-year-old
- B Isolated greater trochanteric fracture with no subtrochanteric extension
- C Reverse oblique intertrochanteric fracture (fracture line running from medial distal to lateral proximal) ✓
- D Undisplaced intertrochanteric fracture in an ambulatory patient
Explanation
The reverse oblique intertrochanteric fracture is a DHS failure pattern — the fracture configuration means the sliding hip screw allows the femoral shaft to displace medially (because the fracture line runs from proximal-medial to distal-lateral; the sliding action of the DHS encourages shaft medialization rather than fracture compression). A cephalomedullary nail (PFNA, InterTAN, Gamma nail) transmits load through the nail-in-the-medullary canal, bypassing the fracture site, and provides superior fixation. Stable two-part and undisplaced fractures are managed adequately with DHS. Isolated greater trochanteric fractures rarely need fixation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.