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Intramedullary nails and sliding hip screws are both established fixation methods for intertrochanteric femoral fractures, but surgeons often favour nails for more unstable patterns. This prospective randomized study compared an intramedullary device with a sliding hip screw in multifragmentary intertrochanteric fractures. The trial found broadly comparable clinical results and highlighted the importance of fracture stability rather than assuming that a nail is automatically superior. Intramedullary fixation can offer biomechanical advantages and a shorter lever arm, while a sliding hip screw remains an effective and familiar option for many stable patterns. The evidence supports matching the implant to fracture morphology, especially the status of the lateral wall, posteromedial comminution and fracture extension. For HCPs, the practical lesson is that implant selection is only one part of success. Accurate reduction, restoration of neck-shaft alignment, control of medial instability and avoidance of cut-out remain central. In older adults, early mobilisation is a key goal because delayed weight-bearing carries its own risks. A thoughtful fracture classification and fixation plan therefore matter more than a blanket preference for one implant family.
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Intramedullary nails and sliding hip screws are both established fixation methods for intertrochanteric femoral fractures, but surgeons often favour nails for more unstable patterns. This prospective randomized study compared an intramedullary device with a sliding hip screw in multifragmentary intertrochanteric fractures. The trial found broadly comparable clinical results and highlighted the importance of fracture stability rather than assuming that a nail is automatically superior. Intramedullary fixation can offer biomechanical advantages and a shorter lever arm, while a sliding hip screw remains an effective and familiar option for many stable patterns. The evidence supports matching the implant to fracture morphology, especially the status of the lateral wall, posteromedial comminution and fracture extension. For HCPs, the practical lesson is that implant selection is only one part of success. Accurate reduction, restoration of neck-shaft alignment, control of medial instability and avoidance of cut-out remain central. In older adults, early mobilisation is a key goal because delayed weight-bearing carries its own risks. A thoughtful fracture classification and fixation plan therefore matter more than a blanket preference for one implant family.
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