الفهرس 
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Abstract
Intertrochanteric femoral fractures are one of the most common fractures seen in the elderly and early operative interference is the standard of care. The fixation methods include 2 main categories, extramedullary and intramedullary. Unstable per-trochanteric fractures continue to represent a treatment challenge because of many reasons.
Because of some theoretical advantages over extramedullary devices, PFNA are widely used for the treatment of these fractures. However, failures and complications may occur especially cutout of the blade. It may not be suitable for patients with severe osteoporosis and excessive bow in the femur.
LISS-DF was reported to have some advantages as buttressing the greater trochanter and the lateral wall. However, as an extramedullary device, LISS-DFcarry an anatomical mismatch to the proximal femur and the screws may not be accurately inserted in the femoral neck. The Minia-PFPA was developed as a modification of LISS-DF to overcome its limitations. It has anatomical match to the proximal femur, the postero-medial fragment could be fixed through the plate, and the screw distribution allow multi-plane fixation.
This study compared this new plate to the most commonly used line of treatment, PFNA trying to help the surgeons in selecting the optimal treatment.The results for both implants were comparable and the differences between them were statistically non-significant.
Post-operative wt-b represent a challenge as it is controlled by many factors related to bone strength, fracture factors (type, comminution, and loss of lateral buttress), fixation quality, body weight, patient cooperation, and the type of implant used. It should be tailored to a regime suitable for each patient according to the above-mentioned data.
The most important factors affecting implant and/or fixation failure is the surgeon’s experience and accuracy in performing the procedure and most of the failures may be caused by improper preoperative planning and technical errors. Nest to this come the fracture configuration and its extension to the greater trochanter, and the lateral wall instability.
The PFNA allows for earlier wt-b, and the Minia-PFPA which allows for multi-planar fixation with enough number of locked screws that could increase the mechanical stability significantly with stress distribution rather than concentration, although a mechanical proof is still deficient.
Preventing excessive fracture collapse and severe osteoporosis represent important issues that may affect the final clinical outcome. The Minia-PFPA may be preferred in these cases than the PFNA.
No ideal implant could be defined, but, detailed pre-operative evaluation is of paramount importance to determine which implant can be advocated for a specific type of fracture in a specific type of patient by a certain surgeon with specific qualifications.
Conclusions:
• Both PFNA and Minia-PFPA were useful and effective.
•The preoperative planning is the cornerstone to determine the patient, fracture, and surgeon factors that give priority for a certain implant.
• We recommend Minia-PFPAfor patients with severe osteoporosis, reduced neck-shaft angle, lateral wall break, and comminuted fractures extending to the greater trochanter, where structural competence could not be offered by nailing, when open reduction is required, and with surgeons whom could not effectively do perfect nailing with less technical errors.