Controversies in the Treatment Strategies of Intertrochanteric Fractures: A Scoping Review and Discussion of a Literature-Based Algorithm

Abstract

Intertrochanteric fractures become more and more relevant in an aging population. Despite significant progress in the treatment of these fractures, some technical details, concerning the surgical procedure, are still a matter of strong debate. In this review of the literature, we have included the best evidence available from the last decade in an effort to shed light on some of the most controversial subjects related to intertrochanteric fractures: Treatment in the case of polytrauma or monotrauma? Reconstruction or arthroplasty? Open or closed reduction? Reconstruction with or without additional cables and plates? Cephalomedullary nail or dynamic hip screw (DHS)? Long cephalomedullary nail or short cephalomedullary nail? The results of this scoping review are controversial. By introducing a new therapeutic algorithm, we do not intend to present a new finished guideline but rather arouse a controversial debate about a relevant aspect in geriatric traumatology. These conflicting results are an indication that larger and more well-conducted, high-quality trials are needed in order to gain more secure answers.