A 70-year-old osteoporotic woman sustains an Evans Type II intertrochanteric fracture of the right hip. The MOST important biomechanical consideration when selecting an implant is:

• A Need for a long stem to bypass the isthmus
• B Patient's haemoglobin level
• C Medial cortical support — stable vs unstable fracture pattern ✓
• D Bone mineral density at L4 spine

Explanation

Evans classification distinguishes stable (medial cortex intact after reduction) from unstable intertrochanteric fractures (posteromedial comminution with loss of medial cortical support). Unstable patterns carry a high risk of fixation failure (cut-out of the screw, varus collapse) with sliding hip screws. Unstable Evans Type II fractures with medial cortex deficiency are better treated with an intramedullary nail (cephalomedullary nail) to provide buttress support and reduce implant stress. Medial cortical buttress is the key biomechanical determinant.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.