Intertrochanteric hip fractures — breaks that occur in the region between the greater and lesser trochanter of the femur — have been treated surgically for decades, and hip fracture fixation has evolved through two main device families that remain in active use today: cephalomedullary nails and dynamic hip screw (DHS) systems. Both approaches share the same broad goal of stabilizing the fracture so a patient can begin mobilizing safely, but they achieve that stability through different mechanical arrangements. Rather than one method having simply replaced the other, both continue to have defined roles depending on the fracture pattern encountered.
What Is a Dynamic Hip Screw System, and How Has It Been Used?
A dynamic hip screw system uses a large screw placed through the femoral neck into the femoral head, connected to a side plate fixed to the outer surface of the femoral shaft with additional screws. The "dynamic" part of the name refers to the screw's ability to slide within a barrel on the plate, allowing controlled compression across the fracture as the patient bears weight and the bone settles during healing. This approach has a long track record, particularly for stable intertrochanteric fracture patterns where the fracture line resists rotational and shortening forces reasonably well on its own once compression is achieved.
What Is Cephalomedullary Nailing, and What Problem Does It Address?
Cephalomedullary nailing uses an intramedullary nail inserted through the tip of the greater trochanter, with a lag screw or blade passing through the nail into the femoral neck and head. Because the nail sits within the femoral canal rather than along the bone's outer surface, it is positioned closer to the mechanical axis of the femur, which is generally described as offering a shorter lever arm and different load distribution compared with a side-plate construct. This design has been increasingly used for unstable intertrochanteric patterns, reverse obliquity fractures, and fractures with subtrochanteric extension, where instability from the fracture line can place greater mechanical demand on the fixation device.
How Do the Two Approaches Compare for Different Fracture Patterns?
Stable fracture patterns — where the posteromedial cortex remains largely intact and the fracture resists displacement — have historically been treated effectively with dynamic hip screw systems. Unstable patterns, including comminuted fractures, reverse obliquity fractures, or those extending into the subtrochanteric region, are more frequently addressed with cephalomedullary nails, in part because of how each device manages the mechanical forces generated by an unstable fracture line. That said, surgeon experience, hospital equipment availability, and individual patient anatomy also factor into this decision, and dynamic hip screw systems remain in active clinical use for appropriately selected fracture patterns rather than having been set aside entirely.
Does the Newer Approach Replace the Older One?
Not categorically. While cephalomedullary nailing has become more widely adopted for unstable fracture patterns over time, dynamic hip screw systems continue to be used where a stable fracture pattern and surgeon judgment support that choice. Neither device is described here as superior in general terms; each has typical advantages tied to specific fracture geometries, and orthopedic trauma training continues to cover both as valid tools. A qualified physician determines suitability for a given patient based on fracture classification on imaging, bone quality, and overall clinical picture.
Where INVAMED's Proximal Femoral Nail Fits This Discussion
Cephalomedullary nailing for intertrochanteric and proximal femoral fractures is supported by proximal femoral nail designs within the CytroFIX intramedullary femoral nail family from Cytronics (an INVAMED orthopedic division), built on the same medical-grade titanium alloy platform used across CytroFIX's femoral nailing systems. As with any implant in this category, appropriate use depends on the individual fracture pattern and is determined by the treating surgeon. General background on the fixation systems used for hip and femoral trauma is available on the INVAMED orthopedic and trauma solutions category page, with country-specific availability and indications outlined in each device's Instructions for Use (IFU).
Is a dynamic hip screw system outdated compared to cephalomedullary nailing?
No. Dynamic hip screw systems remain a valid option for stable intertrochanteric fracture patterns, and many surgeons continue to use them where clinically appropriate. The choice between the two approaches depends on fracture stability and pattern rather than one device having replaced the other entirely.
Why are unstable hip fractures more often treated with a cephalomedullary nail?
Unstable fracture patterns generate mechanical forces that a nail positioned within the femoral canal is generally considered better suited to resist, given its proximity to the bone's central axis. This is a biomechanical consideration weighed alongside the specific fracture classification seen on imaging.
How is the fracture pattern determined before choosing a fixation method?
Surgeons classify intertrochanteric fractures based on imaging, evaluating factors such as the integrity of the posteromedial cortex and whether the pattern is comminuted or extends toward the subtrochanteric region. This classification, combined with patient-specific factors, guides the choice between fixation systems.
Device availability and regulatory status vary by country. Please contact INVAMED or your authorized local distributor for current regulatory information applicable to your region.