1. Treatment of trochanteric fractures of the femur has become that of surgical fixation. The presence of associated geriatric pathology and complications demand team work from the medical, urological, surgical, and orthopaedic staffs.
2. There is a 16.4 per cent chance that a patient with a trochanteric fracture will, at some time, sustain another separate hip fracture. This indicates a need for permanent protection.
3. The original placement of a one-piece Jewett nail, to a large part, determines the outcome. Multiple drives to obtain good position are acceptable and do not adversely influence the end result.
4. Where fixation demands a fully driven nail, the possibility of its later penetration should be accepted.
5. Failure of metallic fixation devices is bound to occur, in regard to both stability in osseous structure and fatigue fracture of time implant. Even if reasonable design of the appliance is present, and its internal structure has been tested by accepted methods, a small percentage of such fatigue fractures should be considered as inevitable.
Copyright 1959 by The Journal of Bone and Joint Surgery, Incorporated