A 55-year-old man sustains an intertrochanteric fracture of the femur classified as AO/OTA 31-A2.2 (unstable 4-part fracture). Which implant provides superior biomechanical stability compared to a Dynamic Hip Screw alone?
- A Blade plate fixation
- B Intramedullary hip nail (proximal femoral nail/PFNA) ✓
- C Austin Moore hemiarthroplasty
- D External fixation
Explanation
Unstable intertrochanteric fractures (reverse oblique, subtrochanteric extension, disrupted posteromedial cortex — AO 31-A2 and A3) are better managed with an intramedullary device (Proximal Femoral Nail Antirotation — PFNA or cephalomedullary nail) because the IM nail has a shorter moment arm (load closer to the mechanical axis), provides antirotation control, and is superior for high-energy or reverse oblique patterns. DHS alone may fail in unstable patterns due to excessive sliding and varus collapse. Blade plate is an older technique. Hemiarthroplasty is reserved for intracapsular fractures or very comminuted trochanteric fractures in elderly.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.