Master the management of intertrochanteric fractures by understanding the critical determinants of fracture stability. Learn exactly when to use a sliding hip screw versus a cephalomedullary nailand how applying the tip-apex distance (TAD) rule prevents lag screw cutout. ⏱ Chapters 0:00 Intro 0:25 Essentials 0:57 Classification 1:27 Ao 1:57 Reverse 2:26 Stable 2:57 Tad 3:22 Cci 3:48 Algorithm 4:21 Numbers 4:49 Clinical reasoning — Stable 5:16 Clinical reasoning — Pearls This comprehensive orthopaedic masterclass provides an in-depth look at extracapsular hip fractures occurring between the greater and lesser trochanters. We cover everything from the Evans/Jensen and AO/OTA classification systems to the biomechanical principles dictating implant selection, ensuring you can confidently assess fracture stability and optimise surgical outcomes for your patients. 🦴 IN THIS VIDEO YOU'LL LEARN • How to classify intertrochanteric fractures using the Evans/Jensen and AO/OTA systems • The four key anatomical factors that determine fracture stability • Indications for using a sliding hip screw versus a cephalomedullary nail • How to accurately calculate and optimise the tip-apex distance (TAD) • The biomechanical importance of the posteromedial cortex and lateral wall thickness • Why a superior lag screw position carries the highest risk of biomechanical failure • The REVERSE mnemonic for remembering absolute indications for cephalomedullary nailing • Why surgical fixation within 24 to 48 hours directly reduces patient mortality ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ Stability is dictated by the posteromedial cortex, lesser trochanter integrity, lateral wall thicknessand fracture obliquity. ✔️ A lateral wall thickness of less than 20.5mm makes a sliding hip screw unsafe, requiring a cephalomedullary nail. ✔️ Always use a cephalomedullary nail for reverse oblique patterns to prevent medialisation of the shaft. ✔️ Keeping the tip-apex distance (TAD) under 25mm reduces the risk of lag screw cutout to less than 1%. ✔️ Aim for a centre-centre or centre-inferior (CCI) lag screw position to minimise biomechanical failure. ✔️ Surgery must be performed within 24-48 hours of admission, as delays directly increase mortality and complications. 👩⚕️ WHO THIS IS FOR This video is designed for orthopaedic trainees, junior doctorsand medical students looking to master trauma concepts. It is also highly valuable for allied healthcare professionals and curious patients wanting to understand the mechanics and surgical decision-making behind geriatric hip fracture fixation. 📚 RELATED TOPICS: Femoral neck fractures and avascular necrosis · Subtrochanteric fracture management and biomechanics · Sliding hip screw biomechanics and dynamic compression · Cephalomedullary nailing technique and implant design · Orthogeriatric care and fragility fracture optimisation · Lateral wall fracture and iatrogenic instability 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #intertrochantericfracture #hipfracture #trauma #cephalomedullarynail #slidinghipscrew #orthopaedicsurgery #fragilityfracture #geriatrictrauma #tipsandpearls #orthopaedicvideos #medicaleducation #fracturefixation #orthovellum