Subtrochanteric Fractures Flashcards
denosumab or bisphosphonate use, particularly alendronate, can be risk factor
subtrochanteric fracture
deforming forces on the proximal fragment
abduction-gluteus medius and gluteus minimus
flexion-iliopsoas
external rotators-
rule out ____ femur fracture
pathologic or atypical
risk factors for atypical or pathologic femur fractures
bisphosphonates or denosumab
deforming forces on distal fragment
adduction and shortening
_____ leads to net compressive forces on medial cortex and tensile forces on lateral cortex
weight bearing
weight bearing leads to net compressive forces on medial cortex and _____ on lateral cortex
tensile forces
Look on ____ xray to identify piriformis fossa extension
lateral
Look on lateral xray to identify _____ extension
piriformis fossa
major criteria suggesting atypical fracture
Associated with no trauma or minimal trauma, as in a fall from a standing height or less
Fracture originates at the lateral cortex and is substantially transverse in its orientation, although it may become oblique as it crosses the medial femur
Noncomminuted
Complete fractures extend through both cortices and may be associated with a medial spike; incomplete fractures involve only the lateral cortex
Localized periosteal or endosteal thickening of the lateral cortex is present at the fracture site
Associated with no trauma or minimal trauma, as in a fall from a standing height or less
Fracture originates at the lateral cortex and is substantially transverse in its orientation, although it may become oblique as it crosses the medial femur
Noncomminuted
Complete fractures extend through both cortices and may be associated with a medial spike; incomplete fractures involve only the lateral cortex
Localized periosteal or endosteal thickening of the lateral cortex is present at the fracture site
major criteria suggesting atypical fracture
minor criteria for atypical fracture
Generalized increase in cortical thickness of the femoral diaphyses
Prodromal symptoms such as dull or aching pain in the groin or thigh
Bilateral incomplete or complete femoral diaphysis fractures
Delayed fracture healing
Specifically excluded are fractures of the femoral neck, intertrochanteric fractures with spiral subtrochanteric extension, pathological fractures associated with primary or metastatic bone tumors, and periprosthetic fractures
Generalized increase in cortical thickness of the femoral diaphyses
Prodromal symptoms such as dull or aching pain in the groin or thigh
Bilateral incomplete or complete femoral diaphysis fractures
Delayed fracture healing
Specifically excluded are fractures of the femoral neck, intertrochanteric fractures with spiral subtrochanteric extension, pathological fractures associated with primary or metastatic bone tumors, and periprosthetic fractures
minor criteria for atypical fracture
presentation:
long history of bisphosphonate or denosumab
history of thigh pain before trauma occurred
physical exam:
pain with motion
typically associated with obvious deformity (shortening and varus alignment)
flexion of proximal fragment may threaten overlying skin
recommended radiographic views
AP and lateral of the hip
AP pelvis
full length femur films including the knee
may assist with defining fragments in comminuted patterns but is not required
traction view
XR findings
proximal fragment flexed and abducted
distal fragment adducted and ER
____ fragment flexed and abducted
proximal
____ fragment adducted and ER
distal
