A 55-year-old man with a Seinsheimer Type V subtrochanteric femur fracture is planned for surgery. Which implant provides the greatest biomechanical advantage in this fracture pattern?
- A Dynamic hip screw (DHS) with side plate
- B Blade plate with fixed angle
- C Locking compression plate (LCP) on the lateral femur
- D Proximal femoral nail antirotation (PFNA) — intramedullary device ✓
Explanation
Subtrochanteric fractures are subjected to the highest compressive stresses in the skeleton (1200 kg/cm²). An intramedullary nail (PFNA or cephalomedullary nail) places the implant within the medullary canal, close to the mechanical axis, minimizing bending moment arm. The DHS, blade plate, and lateral LCP are all extramedullary devices positioned far from the neutral axis, resulting in much higher implant stress and higher failure rates in subtrochanteric fractures. Seinsheimer Type V involves a bilateral subtrochanteric fracture with a lesser trochanter fragment, making an IM nail the best biomechanical choice.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.