In extracapsular fractures there is minimal risk of osteonecrosis of the femoral head.
True intertrochanteric fractures are subdivided according to the fracture pattern. The fracture line passes between the two trochanters, above the lesser trochanter medially and below the crest of the vastus lateralis laterally. Both femoral cortices are involved.
These fractures cause significant shortening and tend to be unstable after reduction and fixation, because both cortices are involved.
These fractures may be treated with a sliding hip screw and plate (DCS), or a cephalomedullary nail. Whichever method of treatment is used, it can be difficult to obtain satisfactory reduction with a closed technique, and it is often necessary to perform an open reduction.
Only stable proximal femoral fractures can be treated with the dynamic condylar screw (DCS) plate. The DCS plate does not allow for controlled collapse and compression.
Note: Because healing of these fractures may take 12 or more weeks, if contraindications can be corrected soon enough, operative treatment of the fracture may be beneficial even if delayed.
If definitive treatment will be delayed for more than 2 or 3 weeks, temporary skeletal traction might be considered to help maintain alignment.