Commentary

This randomized clinical trial highlights several important principles in the management of pertrochanteric and subtrochanteric proximal femoral fractures in the elderly. The authors compared intramedullary and extramedullary fixation for these fractures with respect to pain, function, complications, and radiographic parameters for up to one year. As was the case in previous studies1, the authors were unable to identify a significant difference in functional outcome, although a recent large trial did show a trend toward better recovery of mobility with intramedullary fixation2. In the present study, the authors found that patients treated with nailing had slightly less pain with mobility early on but not after hospital discharge. However, there were differences in the radiographic parameters and some technical issues and complications that bear closer scrutiny.