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The differences in physiology and anatomy account for the difficulty in managing these fractures.
This makes interlocking IMN an effective option in managing these fractures.
Many challenges are faced in managing these fractures including restoring the articular joint surface, the posterior facet and maintaining a good non-infected soft tissue envelope over the fracture site, with a normal foot shape and profile.
We knew already from our existing research that the underlying evidence was insufficient to establish the best methods for managing these fractures.
The consultation group thus included members of the key professions managing these fractures, a patient representative, opinion leaders and active researchers.
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There is little guidance in the current literature as how to manage these fractures and their associated injuries.
Because early weight bearing and motion of the hip joint may cause an incomplete trochanteric fracture to progress to a complete displaced fracture, the decision to manage these fractures conservatively should be carefully considered.
Certain technical pearls are pivotal in managing these difficult fractures with nails; these include rotator cuff management, respect of the soft tissues, anatomic tuberosity position, blood supply maintenance, knowledge of the deforming forces on the proximal humerus, fracture reduction, and rehabilitation strategies.
Unfortunately, the risk factors leading to infection and nonunion when managing these types of fractures with this sequence of fixation are not well defined and the question on the best time to convert an external fixator to an IM nail remains unanswered [13, 14].
Whilst both allow clinicians to define and communicate the fracture pattern, managing these injuries is primarily based on an assessment of stability, which incorporates the amount of displacement, presence of medial injury and associated talar shift [9, 10].
The rationale for using 3D-CT is that it may help surgeons understand the fracture pattern better, and therefore aid in classifying and managing the fractures.
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