Treatment of unstable trochanteric fractures : the balance between man and material

Treatment of unstable trochanteric fractures poses a challenge to surgeons in many ways. Accepting this challenge requires understanding of those parameters that determine the outcome. In operative fracture care at least four elements influence the outcome of treatment: the patient, the fracture, the fixation device, and the surgeon. The degree of impact varies per specific element, as does the mutual relationship. The general physical state of the patient with a hip fracture is a parameter that is strongly related to fracture type and outcome, but cannot or only minimally be influenced by the surgeon: it is a relatively static parameter. The type of fracture that is sustained has similar static characteristics: it presents as a fixed value parameter that both directly and indirectly influences outcome, through its intrinsic stability and its tendency to redislocation. The flXation device that will be used for osteosynthesis depends on the patient, the fracture characteristics~ the way the fracture is classified, hospital logistics and the skills, experience and preference of the operating surgeon. Figure 1 shows a schematic overview this mixture of these factors with their complex and interactive connections. All these factors, separate and combined, apply their influences upon outcome.