6 The choice of implant depends upon the fracture pattern, the age of the patient, and the patient’s existing comorbidities. 7 Many questions still remain regarding the optimal management of proximal femoral fractures. 8, 9 A variety of options for fixation may be considered for basicervical femoral neck fractures. 6 Basicervical femoral neck fractures occur between the base of the femoral neck and the trochanteric region 7 and may be regarded as an intermediate form due to their anatomical location. 5 Subtrochanteric fractures, which occur in the area within 5 cm distal to the lesser trochanter, are prone to nonunion and malunion and require proper reduction before and during fixation to ensure favorable results. 1–4 Intertrochanteric fractures occur in the area between the greater and lesser trochanter and are the most common type of hip fracture, accounting for nearly half of all hip fractures. ![]() Proximal femoral fractures account for a large proportion of hospitalizations among trauma cases, and their clinical burden and costs place a great strain on society. Complicated hypertension was more commonly associated with mechanical displacement. Age 50–64 (vs 75+) and subtrochanteric or pathological fracture were more commonly associated with nail breakage. Half of the breakages occurred within five months after surgery and half of the mechanical displacements occurred within 75 days. The cumulative incidence of mechanical displacement was 0.37% overall, 0.43% for subtrochanteric fractures, 0.42% for combination fractures, and 0.36% for intertrochanteric or basicervical femoral neck fractures. The cumulative incidence of nail breakage over two years was 0.66% overall, 1.44% for combination fractures, 1.16% for subtrochanteric fractures, and 0.49% for intertrochanteric or basicervical fractures. Most fractures were closed (97.2%), intertrochanteric or basicervical femoral neck (80.1%), and not pathological (91.0%). Comorbidities included hypertension (62.9%), osteoporosis (27.3%), cardiac arrhythmia (23.1%), diabetes (30.7%), and chronic pulmonary disease (16.3%). A total of 11,128 patients had IMN fixation for subtrochanteric, intertrochanteric, or basicervical femoral neck fractures: (mean SD) age 75.6 (16.4) years, 66.2% female, 74.3% Medicare supplemental vs 26.7% commercial insurance.
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