Radiographic Findings of Intertrochanteric Frx

- See:
      - Classification
      - Singh index
      - Unstable Intertrochanteric Fractures

- AP view (internal rotation);
    - allows determination of frx obliquity & bone quality;
    - if hip is in external rotation, greater troch rotates posteriorly & will overlie part of the fracture line;
    - determine size, location, & comminution posterior frx fragments, which determines fracture (in)stability;
    - in some cases the lesser trochanter will be fractured w/o comminution but more often there will be associated comminution which makes the frx unstable;

- Lateral:
    - in some cases, an unstable frx pattern may be missed due to an inadequate lateral radiograph, which interferes w/ assessment of size postero-medial comminution and presence of coronal split in the greater troch (4 part frx);

           - diagram of 4 part fracture:

- 5Ps Hip Fracture: Pathologic Hip Fractures:
    - ability of severely osteoporotic bone to bear substantial segment of load is impaired even when collapsible device is used properly.
    - consider placing Sliding Screw more inferiorly in osteoporotic bone;
    - purchase of cortical-bone screws thru side-plates may also be impaired in osteoporotic bone & may result in plate pulling away from shaft;
          - this may be corrected by use of either longer plate & more screws;
    - osteoporotic frxs must be protected w/ limited wt bearing postop;

- Fracture Geometry and Stability: (See Classification)
    - w/ cortical instability on one side of frx owing to cortical overlap or destruction, frx tends to collapse in direction of instability;
    - it is important prior to reduction to distinguish between Unstable and Stable Frx intertroch fractures

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

Last updated by Data Trace Staff on Tuesday, September 18, 2012 3:28 pm