Intertrochanteric Fractures

Question 1

Proximal humerus fractures in elderly women increase their risk of what fracture?

Answer 1

Hip fractures within the first year

Question 2

What are factors that increase the one year mortality following hip fractures?

Answer 2

1) male gender (25-30% mortality) vs female (20% mortality)
2) higher in intertrochanteric fracture (vs femoral neck fracture)
3) operative delay of >2 days
4) age >85 years
5) 2 or more pre-existing medical conditions
6) ASA classification (ASA III and IV increases mortality)

Question 3

What are characteristics of an unstable intertrochanteric femur fracture?

Answer 3

1) posteromedial comminution
2) subtrochanteric extension
3) reverse obliquity
4) lateral cortex comminution

Fracture tends to collapse into varus and retroversion

Question 4

When using a sliding hip screw what is the advantage of using a 4-hole versus a 2-hole plate?

Answer 4

No clinical or bio mechanical advantage

However technical advantage of 4-hole plate is use of additional lateral trochanteric side plate

Question 5

What must you keep in mind with unstable left sided intertrochanteric fractures?

Answer 5

Lag screw advancement and cause flexion malreduction of the proximal fragment

Question 6

What leads to greater screw cutout in the treatment of intertrochanteric hip fractures?

Answer 6

> 25mm tip-to-apex distance with SHS
CM nails have higher incidence in general
45mm TAD a/w 60% cutout rate

Question 7

What is the incidence of nonunion in intertrochanteric fractures?