Fracture Care · Hip & thigh
Hip fracture — Cephalomedullary nail
Intertrochanteric or Subtrochanteric Hip Fracture — Cephalomedullary Nail Fixation
The condition
An intertrochanteric hip fracture is a break at the top of the thigh bone (femur), just below the neck of the hip; a subtrochanteric fracture is a little lower. Most happen in a fall, often when bone is thinned by osteoporosis. It causes severe hip pain and makes standing or walking very hard.
The surgery
Surgery is typically done within a day or two of the injury so you can get up and walking quickly. Through small incisions on the side of the hip and thigh, the bone is lined up and a metal rod (nail) is placed inside the thigh bone, with a large screw up into the ball of the hip and sometimes a screw near the knee. The final plan is determined during surgery.
Recovery at a glance
- Weight-bearing
- Full weight as comfort allows with a walker, starting the day of or after surgery. No hip precautions. (Some complex fractures need touch-down weight for several weeks.)
- Walking
- Walker for the first 2–6 weeks, then a cane as balance allows. The cane is stopped between 6 and 12 weeks, once the limp is gone.
- Daily life
- Walk at least daily and keep up strength and balance exercises at home. No driving while taking narcotic pain medication.
- Recovery
- Most reach their prior level of walking by ~12 weeks; some continue a home or community exercise program after that. Ask about a bone-density check.
A general guide. Your restrictions and timeline may change based on what is found and done at surgery.
Risks & benefits
Benefits: The nail holds the bone in place so you can stand and walk right away, which lowers the risk of pneumonia, clots, and bedsores. Risks are uncommon and include infection, blood clots, pain on the outside of the hip from the nail (common), the screw loosening or cutting through soft bone, the bone healing slowly or not at all, a shorter leg or a limp, fracture around the nail, confusion after anesthesia, injury to nearby structures (such as nerves or blood vessels), stiffness, persistent pain, and the need for further surgery. These will be reviewed with you in detail before surgery.
Patient Surgical Information
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Before & after every surgery