Fig. 7.

Distal locking algorithm for treatment of pertrochanteric fractures with short cephalomedullary nails.

• a) A long nail may be considered in case of subtrochanteric extension or for protection of the femoral shaft (in case of severe osteoporosis, metastatic lesions, or suspected femoral pathology).
• b) Consider using a single static screw instead of two static screws as it may prevent stress concentration and thigh pain.
• c) A method of detecting rotational instability is by gently rotating the insertional jig after inserting the lag screw. If the fragments move as a unit, the fracture is treated as stable.
• d) Consider an extramedullary device as a viable alternative in stable fractures.