- 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
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classification
-
basilar neck frx
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stable intertrochanteric frx
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unstable intertrochanteric frx
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lesser trochanteric frx
-
reversed obliquity
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type-IV
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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
-
intramedullary nail fixation
-
hip arthroplasty
- references:
-
Total hip arthroplasty for complications of intertrochanteric fracture. A technical note.
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Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation.
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Total hip arthroplasty following failed internal fixation of hip fractures.
- Complications: Hardware Failure:
-
Cementless modular hip arthroplasty as a salvage operation for failed internal fixation of trochanteric fractures in elderly patients.
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Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures.
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Hip arthroplasty for failed internal fixation of intertrochanteric fractures
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Total hip arthroplasty for complications of proximal femoral fractures
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Salvage of failed internal fixation of intertrochanteric hip fractures
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Salvage procedures for failed compression hip screw fixation of intertrochanteric femoral fractures: analysis of 50 cases.
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[Conversion total hip replacement after failed internal fixation of intertrochantric fracture]
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Modular Femoral Component for Conversion of Previous Hip Surgery in Total Hip Arthroplasty
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Intertrochanteric femoral fractures. Mechanical failure after internal fixation.
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Avascular necrosis of the femoral head after intertrochanteric fractures.
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.
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.
External fixation of intertrochanteric fractures of the femur.
Postoperative weight bearing after a fracture of the femoral neck or an intertrochanteric fracture.
-
ender nails: (
mentioned for historical purposes only);
- introduced in 1970;
- complications include: nails backing out of IM canal, perforation of nails thru femoral head, distal migration, and external rotational deformity at fracture site;
- references:
-
The use of Ender's pins in extracapsular fractures of the hip.
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Ender nailing for peritrochanteric fractures of the femur. An analysis of indications, factors related to mechanical failure, and postoperative results.
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Unstable intertrochanteric fractures of the hip. Treatment with Ender pins compared with a compression hip-screw.
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A comparative analysis of Ender's-rod and compression screw and side plate fixation of intertrochanteric fractures of the hip.
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Complications of Ender-pin fixation in basicervical, intertrochanteric, and subtrochanteric fractures of the hip.
