Intertrochanteric Fractures Sliding Screw Placement in Femoral Head and Neck Wheeless

Description: Anatomical Considerations:
- osseous anatomy of proximal femur dictates where internal fixation device should be placed for maximum purchase in femoral head;
- maximum bone density is found in the area where compression & tension trabeculae coalesce in the center of the head;
- in 1838, int. trabecular system of femoral head was described by Ward;
- maximum bone density is found in area where compression & tension trabeculae coalesce in the center of the head;
- when these trabeculae are absent, surgeon can expect higher rate of failure with use of device;
- most important aspect of device insertion is secure placement of screw within the proximal fragment;
- hence, insert screw centrally to within 1 cm of the subchondral bone;
- this placement ensures adequate purchase in femoral head & solid fixation of femoral head and neck fragment to shaft fragment;
Wheeless' Textbook of Orthopaedics