The dynamic hip screw (DHS) with trochanteric stabilisation plate (TSP) as the extramedullary power transmission system and the proximal femur nail (PFN) as the means of intramedullary stabilisation are both standard in the treatment of unstable trochanteric femoral fractures in the case of old people. A total of 129 patients (average age: 81,5 years) with 31 A2.2 and A2.3 as well as per-/subtrochanteric femoral fractures were treated by means of osteosynthesis with DHS and TSP (n=64) or with PFN (n=65),and the results plotted in a retro-/prospective study. At low complication rates, the radiological operation results are equally good. 6 revisions were necessary in the case of the DHS with TSP and 4 in the case of PFN. A significantly shorter operation time (44.3 vs. 57.3 min) and a considerably shorter in-patient stay (18.6 vs. 21.3 days) were common with PFN. The application of full-weightbearing immediately after the operation was possible for 97% of the PFN patients and 88% of the DHS patients. In a follow-up 6 months after the operation, the PFN patients displayed a significantly lower pain intensity in the operated leg at the same score for ambulation and the same subjective degree of satisfaction. Unstable pertrochanteric and per-/subtrochanteric femoral comminuted fractures can be treated just as well with PFN as with DHS and TSP. Our study results,however, lead us to recommend treatment with PFN.

The dislocation fracture of the femoral head is the result of high speed trauma. Most of the patients have additional injuries. The prognosis of this kind of fracture of the femoral head depends on the type of fracture, the additional injuries and the age of the patients. The diagnosis and the specific treatment are most important, since most of the patients with this injury are of a younger age. The reposition of the fracture has to be performed within 6 hours. In our opinion, this should be done by surgery if possible. For the operation some routine pelvic X-rays and a CT of the pelvis should be prepared. The therapy depends on the type of fracture. In patients with Type I and II fractures the broken head fragments should be refixed by only taking out small parts of bone which are not elementary for the pressure zone of the femoral head. Younger patients with Type III fractures should always receive the possibility of a screw fixation of the neck of femur, whereas total hip replacement should generally be achieved in the older patient. An exact reconstruction of the dorsal acetabulum must be performed in Pipkin Type IV fractures. The usual approach for Type I-III fractures is the ventrolateral Smith-Peterson and lateral Watson-Jones, for Type IV fractures, the dorsal Kocher-Langenbeck approach. We suggest indometacine as a prophylaxis for ossifications due to high tissue damage. Several scores for the evaluation and documentation of the outcome of this kind of fracture are useful: the clinical results according to Merle d'Aubigne, social status scored by the Karnofsky Index and X-ray results using Brooker and Helfet to classify the heterotopic ossification and post traumatic joint changes.