PFNA shortened surgical time but did not reduce blood loss.Good results scientific assays were achieved with both the reverse LISS and PFNA in each fracture type, which was in accordance with the findings by Zhou et al. [19] and Han et al. [18]. Harris hip scores were comparable in both groups in relation to each fracture type. Another important finding of this study was that not a single mechanical failure was found in all the 87 fractures. This probably contributed to good quality of reduction, properly positioning of the internal fixation devices, as well as more conservative rehabilitation program. Every effort was made to obtain best reduction and ideal implants positioning. On rare occasions, close reduction was not satisfactory and open reduction was performed (3 cases in PFNA group, 4 cases in LISS group).

As to postoperative treatment, joint movement was encouraged on second postoperative day for every patient in both groups. The time to start weight-bearing differed widely. In our opinion, the appropriate time to begin with weight-bearing depends not only on the implant used, but also on the fracture type, postoperative stability, osteoporosis, and body weight as well. Haidukewych [20] highlighted 4 classic intertrochanteric fracture patterns that signify instability. The unstable patterns include reverse obliquity fractures, transtrochanteric fractures, fractures with a large posteromedial fragment implying loss of the calcar buttress, and fractures with subtrochanteric extension. He suggested nailing for these fractures.

In this study, weight-bearing was delayed in patients with these classic fracture patterns, regardless of treatment groups.A weakness of this study is that we are familiar with PFNA but not with reverse LISS, for it is originally designed for distal femur. Another weakness is the relatively small patient group. Further studies are required concerning LISS application to proximal femur. In conclusion, the results of the present study show that both the PFNA and the reverse LISS provide effective methods of treatment for intertrochanteric hip fractures. PFNA is superior to reverse LISS in terms of surgical time, weight-bearing, and perhaps fluoroscopy time. Mechanical failure can be minimized when the rehabilitation program is made based on individual characteristics.

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