An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to be adequate reduction and internal fixation. The treatment of intertrochanteric fractures of the hip has evolved along with changes in the design of the implants used to fix them, but there remains conflicting evidence to guide the choice of implant. Helpful instruments for reducing proximal femur fractures include schanz screws and thandle, balltipped pusher, and larger pointed reduction forceps. One of the most common surgical treatments for this type of hip fracture is an open reduction and internal fixation orif. Subtrochanteric and intertrochanteric treatment with plate orif peritrochanteric femur fractures extracapsular hip fractures involving the trochanter and frequent extension into the subtrochanteric region evaluate for pathologic fracture if radiographs or medical history indicate incidence elder patient population. Intertrochanteric femur fracture statpearls ncbi bookshelf.
Intertrochanteric fractures of the hip are one of the most common fractures in elder osteoporotic patients, and usually treated by internal fixation. Femoral neck fracture following intertrochanteric fracture. How are intertrochanteric hip fractures classified. Two techniques for unstable intertrochanteric femoral fracture. Detailed step by step desription of nailing for trochanteric fracture, intertrochanteric located in our module on proximal femur. A prospective, comparative study was done over a period of 3 years to compare the complications and functional results of two treatment modalities of unstable intertrochanteric fractures of the femur in the elderly.
Unusual mode of failure of intertrochanteric femur fracture. Comparison of complications and functional results of. Operative treatment is complicated further by the need for extensive surgical exposure. This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. Just like the intertrochanteric crest on the posterior side of the femoral head, the intertrochanteric line marks the transition between the femoral neck and shaft. Aug 17, 2017 intertrochanteric fracture of the femur. Flow diagram demonstrating methods for identification of studies to assess the treatment of osteoporotic intertrochanteric femur fractures aoota type 3.
These fragility hip fractures occur in a characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of falls. This system is based on the fracture pattern and the ability to obtain a stable reduction. Of the various fracture patterns, intertrochanteric injuries have the lowest rate of complications. Pdf comparision of pfn and intertan nail for unstable. Intertan nail versus proximal femoral nail antirotationasia. Evans classification of intertrochanteric fractures. The method provides good initial stability, a source of cancellous bone graft, good postoperative. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw. Kyle key points the treatment of intertrochanteric femur fractures is nearly always operative.
Failure of fixation of trochanteric femur fractures. Intertrochanteric fractures are defined as extracapsular fractures of the. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. In most cases, surgery is recommended because this fracture can take a long time to heal on its own. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. However, in cases with free bone fragments in the greater trochanter. Evidence from two or more moderate strength studies with consistent findings, or evidence. Rashid s, dar g, kangoo ka, halwai ma 2008 external fixation in the management of intertrochanteric fractures in elderly high risk patients. Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. Randomized clinical trials rcts to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from cochrane library up to january 2018, cnki china national knowledge infrastructure, wanfang data, pubmed, and embase. The most common treatment for intertrochanteric fractures is surgery. The intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Stress fracture, left femur, initial encounter for.
What is the anatomy relative to intertrochanteric hip fractures. Valgus intertrochanteric osteotomy for femoral neck nonunion. The most frequent mode of failure is screw cutout through the head. There are several subtypes of fractures which require different. Proximal femur nail in intertrochanteric fractures. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary. Owing to the good blood supply in intertrochanteric femur fractures, conservative treatment is possible because of the low incidence of nonunion and avascular necrosis, but the complications of immobilization in elderly patients lead to increased mortality and morbidity up to 60% with conservative treatment 1, 2. Smartdraw includes s of professional healthcare and anatomy chart templates that you can modify and make your own.
Fractures of the intertrochanteric region are most commonly occurring fractures of proximal femur. Intertrochanteric fracture definition of intertrochanteric. Most intertrochanteric fractures are treated surgically. Intertrochanteric definition of intertrochanteric by. Pdf femoral neck fracture following intertrochanteric. Create healthcare diagrams like this example called evans classification of intertrochanteric fractures in minutes with smartdraw. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Inclusion criteria were intertrochanteric femur fracture with long intramedullary nail imn fixation and age equal to or older than 18 years.
Treatment options include revision operative fixation with grafting, proximal femur osteotomy, and arthroplasty in elderly patients. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic. Femoral head fractures femoral neck fractures intertrochanteric fractures subtrochanteric. Intertrochanteric hip fractures clinical presentation. Thirtysix patients with unstable intertrochanteric femoral fractures and.
Moderate evidence supports the use of either a sliding hip screw or a cephalomedullary device in patients with stable intertrochanteric fractures. For the first time in my life i feel that i am not alone trying to surpass my bulimia. Depending on when this happened would help explain the findings. He recognized that extracapsular fractures united, whereas intracapsular fractures did not. Hip fracture rehabilitation protocol outpatient or subacute physical therapyphase i weeks 16 postop patient is evaluated weekly in outpatient pt unless deemed otherwise, or in inpatient setting goals. Intertrochanteric fractures are considered 1 of the 3 types of hip fractures.
Ihle on intertrochanteric fracture pathophysiology. There are approximately 150,000 intertrochanteric fractures annually in the united states with an annual incidence of 63 and 34 per 100,000 population per year for elderly females and males, respectively. Intertrochanteric neck and head hip fractures fractures examples of treatment 31a with dhs 31b and c with hemiarthroplasty we will further discuss the 31a fractures. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. Fractures of the femur distal to the lesser trochanter are less common than the femoral neck and intertrochanteric fractures. These fractures are called intertronchanteric hip fractures.
These fragility hip fractures occur in a characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities. Comparing the intramedullary nail and extramedullary. Callus is what we look for to show signs of healing. Intertrochanteric femur fractures orthopaedicsone articles. Compression hip screws are best used in stable fracture patterns and are associated with low rates of complications when properly positioned within the center of the femoral head. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. Treatment of intertrochanteric hip fractures in elderly. Nov 15, 2010 we report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident. Classification fractures in these regions can be classified as. It is therefore important that the treatment methods are effective and have a minimal risk of complications. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used. The otaao type 31 a3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant.
A 36yearold caucasian man was admitted with this rare fracture combination, and. Intertrochanteric fractures are a common injury of the proximal femur, and are classed as an extracapsular femoral neck fracture. An xray of the right hip reveals an intertrochanteric fracture a fracture between the greater and lesser trochanter of the femur. Total hip arthroplasty for intertrochanteric fracture. Concomitant ipsilateral subcapital and intertrochanteric. Valgus intertrochanteric osteotomy is an effective method of treating femoral neck nonunion by reducing shear forces at the fracture and correcting the neckshaft angle. Treatment of unstable intertrochanteric fractures with. Reverse obliquity fractures are best treated as subtrochanteric fractures with either a 95 degree fixed angle implant or an intramedullary device ipsilateral fracture of the femoral shaft, although more common in association with femoral neck fractures, should be. Proximal femoral fractures per and intertrochanteric hip. Hip fracture rehabilitation protocol heywood ortho. Methods fiftyfour operated cases of twopart intertrochanteric ao 31a1 were analysed and divided into. Nailing for trochanteric fracture, intertrochanteric. Intracapsular fractures of the femoral neck per and. The primary care provider calls for an orthopedic consultation.
Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. Treatment by modified medial displacement and valgus osteotomy. Patients with femoral neck and intertrochanteric fractures. Controlled study on gamma nail and proximal femoral locking plate. Pdf management of intertrochanteric fractures with short. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks.
A comparison of the long gamma nail with the sliding hip. Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with porotic bones, usually due to lowenergy trauma like simple falls. Intertrochanteric fracture is one of the most common fractures suffered by elderly patients, and its incidence has been increasing yearly 1, 2. Femoral hip fractures are a common occurrence in the elderly. Intertan and pfn are currently good options in the treatment of unstable intertrochanteric femoral fractures and sustain enough stability during healing period in mobile patients. Video lecture with narrations and live annotations from. To access free multiple choice questions on this topic, click here. Intramedullary fixation using different types of nails is commonly preferred. What makes an intertrochanteric fracture unstable in 2015. Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. Introduction unstable intertrochanteric femoral fracture, such as comminuted fracture and wedge fracture, often occur in. Avascular necrosis and related complications following.
A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Age is the most dominant factor in hip fracture injuries, with most cases occurring in people over 75. The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of. Intertrochanteric fractures account for nearly 50% of all fractures of the proximal femur. Kanchana registrar in surgery teaching hospital peradeniya 2. Treatment of intertrochanteric fractures of the femur pdf. Intertrochanteric hip fractures are among the most common types of fractures, and the numbers are increasing as the population ages.
No osteoporotic changes to the bone are seen on xray. Extracapsular fractures of the proximal femur between the greater and lesser trochanters. Intertrochanteric it femur fractures comprise approximately. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Jan 02, 2017 intertrochanteric fractures of femur 1. These hip fractures are usually the result of a fall and often are the hardest type of fracture to treat. Nonunion of intertrochanteric fractures is uncommon but its effects are disabling. Jan 04, 2016 lecture 4 of 4 on proximal femur fractures adapted from ota lecture series. Femoral neck fractures may proceed to nonunion due to a suboptimal healing environment experiencing high shear forces. Nov 12, 2019 the involved patients were collected from the clinics database based on a computer query of current procedural terminology cpt codes for trochanteric fractures. The boyd and griffin scale was the first system to attempt to classify these fractures but since simpler evans and ao classifications have also been proposed.
Intraarticular fractures of the distal radius malone classification. Valgus intertrochanteric osteotomy for femoral neck. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. The recovery program is giving me the chance that i was seeking to change my life and to free me of the bulimia. A valgus intertrochanteric osteotomy corrects varus collapse and reorients a vertical fracture with a high pauwels angle.
Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. Barton tm, gleeson r, topliss c, greenwood r, harries wj, chesser tj. Add the power of cambridge dictionary to your website using our free search box widgets. Surgical treatment of type 31a1 twopart intertrochanteric. Pdf nonunion of intertrochanteric fractures of the femur. Intertrochanteric fractures of the upper femur occur in the region of the femur bounded by the femoral neck and lesser trochanter medially and the greater trochanter laterally. Scott ih 1957 treatment of intertrochanteric fractures by skeletal pinning and external. The present study was undertaken to assess outcome of 50 patients. Intertrochanteric hip fractures occur outside of the joint. The increase of age is related to the increase of the incidence of hip fracture, which is the most frequent cause of hospitalization in centenarians, overcoming congestive heart failure and respiratory infection. What is the anatomy relative to intertrochanteric hip. There is a greater trochanter on the outside and a lesser trochanter on the opposite side. Apr 21, 2020 treatment of complex proximal femoral fractures with the proximal femur locking compression plate.
Occurrence of mechanical failure is rare and usually involves the shaft of the plate. Another metaanalysis recommend the intramedullary nail technique for the treatment of unstable femoral intertrochanteric fractures due to better functional outcomes and. All fractures were unstable, 22 of them of the type 31a2 prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. Apr 21, 2020 the intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. We describe a modification of the medial displacement and valgus osteotomy of dimon and hughston 1967 which we used in seven fractures, six of which united within 16 weeks. Top 21 on intertrochanteric fracture pathophysiology. Jun 22, 2014 cooper described an intertrochanteric fracture in his treatise of 1851 recommended treatment was moderate extension and steady support of the limb in its natural position. Proximal femur fractures 4 intertrochanteric hip fractures.
Introduction the implant of choice for twopart intertrochanteric femur fracture is still under debate. Treatment of intertrochanteric fractures of the femur. Good outcomes have been reported in the literature. Fracture classification the proximal femoral fractures are classified as 31 fractures. Unsp fracture of shaft of right femur, init for clos fx. Various modes of failure in an operated case of itf fracture have been described. Classification of intertrochanteric hip fractures is based on a system introduced by evans in 1949. Full weight bearing, harris score of hip joint, complication. We advocate fixation of 31a1 fractures with a sliding hip screw and all others with an intramedullary device. Top 21 on intertrochanteric fracture pathophysiology healthtap. Introduction the trochanteric area of the femur is the region of the femoral metaphysis between the base of the femoral neck and the most distal level of the lesser trochanter. Hip replacement as alternative to intramedullary nail in. Nondisplaced intertrochanteric fracture of unspecified femur, initial encounter for open fracture type i or ii. The femoral neck is the most common location for a hip fracture.
Intertrochanteric it fractures are one of the most common types of fracture, with a growing incidence subsequent to increasing longevity of the population. Intertrochanteric neck and head hip fractures fractures examples of treatment 31a. The lesser trochanter is an attachment point for one of the major muscles of the hip. The 31a3 fracture accounted for 5% of all intertrochanteric and subtrochanteric fractures. Pdf the treatment of intertrochanteric fractures of the. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. Stable intertrochanteric fractures aoota type 31a1 can be successfully treated with conventional implants such as dynamic hip screws dhss and proximal femoral nails pfns. Doctor answers on symptoms, diagnosis, treatment, and more. A hip fracture is a break that occurs in the upper part of the femur thigh bone. The treatment of intertrochanteric fractures of the femur with endovis nail. The intertrochanteric aspect of the femur is located between the greater and lesser. It varies in time before it becomes visible on an xray. This study was done to compare the operative parameters and functional outcome of twopart intertrochanteric fractures treated by dynamic hip screw dhs and proximal femur nail pfn.
The goals of treatment include a predictable union, unrestricted early weight bearing, and. Safe ambulation with or without assistive device, with min to no assist. An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to. Among elderly hip fracture patients, intertrochanteric fracture accounts for more than 6070% of cases with an annual mortality rate of 1520% 3,4,5. Nail or plate fixation of intertrochanteric hip fractures. The dynamic hip screw fixation is a commonly used modality of treatment for intertrochanteric femur itf fractures.
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