The Hip: Preservation, Replacement and Revision Tracking Pixel
Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Intertrochanteric Fractures


- 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 frx;
    - 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
    - intramedullary nail fixation

    - hip arthroplasty
           - references:
                - Total hip arthroplasty for complications of intertrochanteric fracture. A technical note.
                - Treatment of unstable intertroch & subtroch frx in elderly patients. Primary bipolar arthroplasty compared w/ IF. 
                - 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.
   - 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
   - Intertrochanteric femoral fractures. Mechanical failure after internal fixation.
   - 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.
- Ender nailing for peritrochanteric fractures 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.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Saturday, September 13, 2014 6:02 pm