A 72-year-old woman sustains an intertrochanteric femur fracture classified as AO/OTA 31-A2.2 (unstable, 3-part). The BEST implant choice to restore the medial buttress and resist varus collapse is:
- A Cannulated hip screws (parallel cancellous screws)
- B Cephalomedullary nail (short or long proximal femoral nail) ✓
- C Dynamic hip screw (DHS) with trochanteric stabilisation plate
- D Bipolar hemiarthroplasty
Explanation
For unstable intertrochanteric fractures (AO 31-A2 and A3), cephalomedullary nails (proximal femoral nail antirotation — PFNA, or Gamma nail) are preferred over the DHS. The nail sits in the medullary canal, significantly reducing the bending moment arm at the implant-bone interface compared to the extramedullary DHS, thereby lowering the risk of varus collapse, cut-out, and implant failure. The DHS with trochanteric stabilisation plate can manage some unstable patterns but is now generally superseded by IM nailing for A2.2 fractures. Cannulated screws are inappropriate for intertrochanteric fractures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.