الفهرس 
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Abstract
Trochanteric hip fractures are one of the most common fractures especially in elderly osteoporotic patients.The hip joint is a ball and socket joint. The primary function of the hip joint is to provide dynamic support to the weight of the body/trunk while facilitating force and load transmission from the axial skeleton to the lower extremities, allowing mobility.
The incidence of hip fracture varies considerably among various populations, but it is estimated that as many as 1.7 million people worldwide suffer from hip fractures each year, and this number has been increasing by about 25% each decade.
Several classification systems for intertrochanteric hip fractures exist.In 1949, Evans developed a classification system for intertrochanteric hip fractures based on the direction of the fracture line, number of fractured fragments, fragment dislocation, and stability.The most commonly used classification system for intertrochanteric femur fractures for clinical and research purposes is the AO classification system that was introduced in 1990.
Ninety percent of elderly hip fractures result from a low-energy fall.Patients with hip fracture have pain in the groin and are unable to bear weight on the affected extremity. Pain may be referred to the distal femur or upper knee.A stress fracture or a non-displaced fracture may have no obvious deformity. However, most patients have some fracture displacement.
Standard anterior-posterior (AP) and lateral views of the fracture are usually enough to adequately diagnose and classify; however, due to severe pain, sometimes only one view can be
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achieved. Computed tomography is rarely necessary, but should be considered for adequate classification and stability assessment of the fracture. Overall careful pre-operative fracture visualization is the key to a reliable classification and implant choice.
Surgical treatment reduces morbidity and mortality by permitting early mobilization and reduction of the risks of prolonged bed rest for the elderly patient. However, the ideal osteosynthesis system for the fixation of these fractures, particularly unstable and comminuted, is still controversial.
Proximal femoral nails have been widely used for the treatment of unstable intertrochanteric fractures as they have a good biomechanical stability and acceptable clinical outcomes, and have some theoretical advantages over extramedullary devices as they give support to postero-medial wall and resist excessive collapse.
Sliding Hip Screw commonly used implant and extensively studied for extra-capsular hip fractures. It is an extra-medullary fixation device that works on the concept of stabilizing the fracture but allowing controlled collapse of the fracture by allowing the screw to slide in the barrel.
Hemiarthroplasty has been proposed as an alternative to internal fixation by few authors for unstable intertrochanteric fracture is frail in elderly patients.
The study conducted on adult patients with acute unstable trochanteric hip fractures. The study was carried out on 18 patients attending to Orthopedic Surgery Department, Faculty of MedicineZagazig University.
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This study has the limitations of being a small sample size, short follow up period and no control group. A future study with a large sample size and long term follow up would provide a better evaluation of the studied fracture and treatment methods.
PFN works well in the treatment of unstable proximal femoral fractures. The functional outcome of these fractures was demonstrated to be significantly acceptable, and it is important to warn patients and relatives of the severity of such injuries. The use of PFN providing a stronger fixation of the proximal part and reduce mechanical complications following the treatment of unstable intertrochanteric hip fractures.