Rehabilitation protocols in unstable trochanteric fractures treated with cephalomedullary nails in elderly: current practices and outcome

  • Xavier Lizano-Díez
  • Marius Johann Baptist Keel
  • Klaus Arno Siebenrock
  • Marc Tey
  • Johannes Dominik BastianEmail author
Review Article



Optimal rehabilitation treatment after surgery for fixation of unstable trochanteric fractures is challenging in elderly patients.


The objective of this study is to analyse the existing literature on available rehabilitation protocols with regards to permitting or restricting early weight bearing following fixation of unstable trochanteric fractures treated by the use of cephalomedullary nails in patients at least 65 years of age.


A systematic review was performed based on the checklist of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies published between 1948 and 2018 on elderly patients with unstable trochanteric fractures treated with cephalomedullary nails that offered information on the postoperative rehabilitation protocol have been selected. Subsequently, the results and complications have been analysed according to the protocols.


Fifteen of the 7056 initial articles have been selected for analysis. Authors who did not restrict weight bearing to their patients reported a shorter hospitalization time and a lower orthopaedic complication rate but a greater systemic complication rate, worse functional scores, and a higher reoperation and mortality rates. Those results should be taken with caution because of the heterogeneity of provided clinical information and the fact that none of the included studies considered the different rehabilitation protocols as study variables to analyse its influence on the results.


With evidence available to date, there is no clear agreement on the postoperative rehabilitation protocol following fixation of an unstable trochanteric fracture by cephalomedullary nail in the elderly.


Trochanteric Unstable Nail Aftercare Rehabilitation Weight bearing 



We thank Mr Vasanthakumar Eswaramoorthy FRCS (Tr & Orth), Arthroplasty Fellow, St. George’s University Hospital NHS trust, London for linguistic support in the preparation of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest for the present investigation.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyFundació Hospital de L’Esperit Sant, Universitat de Barcelona (UB), Santa Coloma de GramenetBarcelonaSpain
  2. 2.Department of Orthopaedic and Trauma SurgeryUniversity of Bern, InselspitalBernSwitzerland
  3. 3.Trauma Center Hirslanden, Clinic HirslandenZurichSwitzerland
  4. 4.Department of Orthopaedic Surgery and Traumatology, Parc de Salut Mar, Hospital del Mar and Hospital de L’EsperançaUniversitat Autonoma de Barcelona (UAB)BarcelonaSpain

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