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Sliding Hip Screw w/ Unstable Frx

- See:
       - Sliding Screw Insertion Technique 
       - Sliding Screw Fixation in Subtroch Frx

- Discussion:
    - treatment of unstable intertrochanteric frxs w/ sliding screw device w/o obtaining necessary bony stability, risks hardware failure;
          - if device impinges, it will act as a fixed angle nail plate and will result in either cutting out or penetration of the head as the unstable frx settles into a position of bone stability;
    - because sliding hip screw allows controlled collapse at frx site, unstable frxs which are anatomically reduced can be expected to impact spontaneously to stable & often medially displaced position;
          - as slinding device shortens w/ settling of unstable frx, the lever arm acting on the nail on the nail plate junction shortens w/ settling of the unstable frx, thereby reducing force on the implant;
          - unstable frx treated w/ sliding device may undergo shortening and medial displacement, but frx tend to go onto union;


          - the following example is self explanatory as to why sliding screws should be used w/ caution in treating subtrochanteric fractures;


    - trochanteric stabilization plate:
          - the trochanteric stabilization plate is designed to fit onto a DHS (dynamic hip screw) and has an superior extension of the plate which provides lateral support for the trochanter prevents excessive
                medial displacement of the shaft fragment;
          - in the study by Madsen et al. 1998, there was 6%; 
          - Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw.

Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures: an Important Predictor of a Reoperation.