intertrochanteric, Peritrochanteric , subtrochanteric fractures Flashcards
what is subtrochanteric fracture?
it is a fracture occurring from lesser trochanter and 5cm distal to it
wha is peritrochanteric fracture ?
subtrochanteric fracture with intertrochanteric extension
what is the classification of subtrochanteric fractures ?
classifiation of subtrochanteric fracture RUSSEL TAYLOR CLASSIFICATION
type 1 - there is no fracture extension to the priformis fossa
a - lesser trochanter is attached to the proximal fragment
b - lesser trochanter dettchamnet from the proximal fragment
type 2 - extension into the priformis fossa
a - stable medial buttress
b - comminution of lesser trochanter
what is the clinical presentation of subtrochanteric fracture ?
long history of bisphosphonate or denosumab/ or thigh pain before trauma has occurred
hip and thigh pain
inability o bear weight
pain with motion
shortening and varus alignement of the proximal fragment
what is the cause of subtrochanteric fractures ?
other than high energy trauma in young and low energy fall in old
densoumab or bisphosphanate use related
if it is bisphosphanate related fracture what should we check out for ?
lateral cortical thickening
diaphysial cortical thickness
transverse vs short oblique fracture orientation
lack of comminution
patient will complain of symptoms before fracture occurs!!
how do we treate subtrochanteric fractures
first aid same as before
open reduction and internal fixation with inter medullary rod (cephalomedually nail)
- the inter medullary rod has piriformis fossa entry
and two cancellous lag screw through the rod into the proximal femur
type 1 - no extension to piriformis fossa and fracture below the lesser trochanter
im nail with standard screw fixation
we can also use a fixed angle plate with locked cortical screws
may function as a tension band
what is the complication of IM ?
varus and procurvatum (flexion) malreduction
nonunion
advantages of IM
stronger construct and load sharing preserves vascularity
INTERTROCHANTERIC FRACTURES ARE AS COMMON AS FEMORAL NECK FRACTURES what is the prognosis of intertrochanteric fractures ?
20-30% mortality risk in the first year following fracture
factors that increase mortality
male gender (25-30% mortality) vs female (20% mortality)
higher in intertrochanteric fracture (vs femoral neck fracture)
operative delay of >2 days
surgery within
age >85 years
2 or more pre-existing medical conditions
what is the classification of intertrochanteric fractures ?
stable
intact posteromedial cortex
clinical significance :
will resist medial compressive loads once reduced
unstable non intact posteromedial cortex thinner lateral wall thickness clinical significance fracture will collapse into varus and retroversion when loaded
what is the clinical presentation of intertrochanteric fractures ?
shortened , externally rotated lower extremity
what is the treatmnet for intertrochanetric fractures ?
nonoperative - non weight bearing with early out of bed to chair position
for non ambulatory patients
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operative
sliding hip compression screw
indications - stable intertrochanteric fractures
lag screw with tip apex distance of more than 25mm is associated with increased failure rates
intermeduallry hip screw for stable fractures (same effective in sliding hip screw) unstable fractures rêver obliquity fractures subtrochanteric extension fractures lack of integrity of the femoral wall
arthroplasty
severely comminuted
preexisting degenerative arthritis
osteoporotic bone
what re the complications of intertrochanteric fractures ?
sliding hip compression screw -
first aid for intertrochanetric fractures ?
balanced skeletal traction
treating any femoral fracture to splint the whole leg as soon as possible, and before transport of the patient. For that purpose you need two firm boards or sticks along the leg, suitably padded, one on the inside and one along the leg and the body on the outside The splints should then be kept in place by bandages around both splints
