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1Preliminary remarks

Extramedullary and intramedullary fixation devices are available for unstable type of multifragmentary pertrochanteric fractures


In general, extramedullary and intramedullary fixation devices are available for the treatment of unstable fractures of the proximal femur. Currently, there is insufficient evidence to say which is best.
Fixation with a cephalomedullary device allows immediate full weight bearing postoperatively. However, it is more difficult than extramedullary fixation and more intraoperative problems may arise. Immediate weight bearing is a must for the elderly. This justifies the preference for intramedullary devices. The Proximal Femoral Nail Antirotation (PFNA) device is a short intramedullary nail which uses a spiral blade device to obtain fixation in the femoral head, rather than a conventional screw. The operative technique for other cephalomedullary devices is similar, but for details see the manufacturer’s guides.