Proximal IM nailing of unstable trochanteric fractures: minimally invasive reduction aids - a review

Proximal femoral nailing is indicated for unstable trochanteric fractures (AO 31-A2, A3) such as fractures with a large posteromedial fragment, with three or four fragments, reverse oblique fractures, and those with sub trochanteric extension. The advantages of nailing are ease and speed of application together with minimal exposure and better biomechanical properties. 

Instability is the likelihood of difficulties in achieving accurate fracture reduction and of loss of reduction after fixation. As bone fragility, i.e., osteoporosis, and fracture instability facilitate fixation failure, unstable trochanteric fractures should undergo anatomical reduction & proximal femoral nailing with a femoral neck-head sliding component to produce a bone-implant construct stable enough to provide for early painless full weight-bearing.