- Discussion:
- frx occur as a result of a fall - from direct and indirect forces;
- occurs along lines between greater and less trochanters;
- theoretically extracapsular, however, it is not always possible to distinguish betwee intertroch
and basilar femoral neck fracture;
- extracapsular intertroch frx occur thru cancellous bone, which has an excellent blood supply - hence, heals well;
- that portion of the neck that is intracapsular has essentially no cambium layer in its
fibrous covering to participate in peripheral callus formation;
- therefore, healing in femoral neck area is dependent on endosteal union alone;
-
forces acting on the hip joint
-
classification
-
basilar neck frx
-
stable intertrochanteric frx:
-
unstable intertrochanteric frx:
-
lesser trochanteric frx
-
reversed obliquity:
-
type-IV
-
4 part frx
- Radiographic Findings:
- Non Operative Rx:
- even w/o treatment, frx usually stabilizes w/ in 8 wks & allows wt bearing in 12 weeks;
- however, marked varus of head & neck w/ assoc external rotation deformity usually results in a short leg gait & limp;
- Operative Treatment:
-
surgical work up:
-
sliding screw insertion technique:
-
closed reduction
-
nail placement and depth:
-
intramedullary hip screw:
-
hip arthroplasty
- references:
- Total hip arthroplasty for complications of intertrochanteric fracture. A technical note.
BM Patterson et al. JBJS-Am. Jun 1990. Vol 72 (5) p 776-777.
-
Treatment of unstable intertroch and subtroch fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation.
-
Total hip arthroplasty following failed internal fixation of hip fractures.
-
ender nails: (
mentioned for historical purposes only);
- introduced in 1970;
- complications include: nails backing out of the IM canal, perforation of nails thru the femoral head, distal migration, and external rotational
deformity at the fracture site;
- references:
-
The use of Ender's pins in extracapsular fractures of the hip.
-
Ender nailing for peritroch frx of the femur. An analysis of indications, factors related to mechanical failure, and postoperative results.
-
Unstable intertrochanteric fractures of the hip. Treatment with Ender pins compared with a compression hip-screw.
-
A comparative analysis of Ender's-rod and compression screw and side plate fixation of intertrochanteric fractures of the hip.
-
Complications of Ender-pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip.
- Complications: Hardware Failure:
-
Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients.
-
Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures.
-
Hip arthroplasty for failed internal fixation of intertrochanteric fractures
-
Total hip arthroplasty for complications of proximal femoral fractures
-
Salvage of failed internal fixation of intertrochanteric hip fractures
-
Salvage procedures for failed compression hip screw fixation of intertrochanteric femoral fractures: analysis of 50 cases.
-
Conversion total hip replacement after failed internal fixation of intertrochantric fracture
-
Modular Femoral Component for Conversion of Previous Hip Surgery in Total Hip Arthroplasty
Current Concepts Review. Timing of Operative Treatment of Fractures in Patients Who Have Multiple Injuries.
Early versus delayed stabilization of femoral fractures. A prospective randomized study.
The fixation and prognosis of trochanteric fractures. A randomized prospective controlled trial.
Intertrochanteric femoral fractures. Mechanical failure after internal fixation.
Postoperative improvement of walking capacity in patients with trochanteric hip fracture: a prospective analysis 3 and 6 months after surgery.
The effect of adjunctive methylmethacrylate on failures of fixation and function in patients with intertrochanteric fractures and osteoporosis.
Comminuted intertrochanteric fractures treated with a Leinbach prosthesis.
Trochanteric fractures. Mobility, complications, and mortality in 607 cases treated with the sliding-screw technique.
Analysis of six hundred and twenty-two intertrochanteric hip fractures.
Fracture of the neck and intertrochanteric region of the femur in children.
External fixation of intertrochanteric fractures of the femur.
Intertrochanteric femoral fractures. Mechanical failure after internal fixation.
Avascular necrosis of the femoral head after intertrochanteric fractures.
EJ Baizauli et al. Journal or Orthopedic Trauma. Vol 13. No 2. 1999. p 134.
Postoperative weight bearing after a fracture of the femoral neck or an intertrochanteric fracture. KJ Koval et al. JBJS. Vol 80-A. No 3. March 1998. p 352.
