قراءة
عرض

Subtrochanteric Fractures

Dr. Jamal Al -Saidy M.B.Ch.B. .F.I.C.M.S
 Within 5cm from lesser trochanter
 in young adults large forces are needed to cause the fractures in this area .
 in the e lderly, the fracture quite frequently, the injury is relatively trivial; here
the reason is a weakening of bone in this area by :-
 osteoporosis
 osteomalacia
 Paget’s disease
 a secondary deposit
 Blood loss is greater than with femoral neck or trochanteric fractures .
 There may be subtle extensions of the fracture int o the intertrochanteric
region.
 The proximal part is abducted and externally rotated by the gluteal muscles,
and flexed by the psoas.

Clinical features

 The leg lies in n eutral or external rotation
 looks short
 the thigh is markedly swollen.
 Movement is excruciatingly painful.
 X-ray :-The fracture is through or below the lesser trochanter. It may be
transverse, oblique or spiral, and is frequently comminuted.
Treatment
 Traction may help to r educe blood loss and pain, until the patient, is
stabilized and prepared for surgery.
 Open reduction and intern al fixation is the treatment of choice.
 Two main types of implant are used for fracture fixation:
(a) an intramedullary nail with a proximal interlockin g screw that can be
directed into the femoral head o r placed in the standard manner
(b) a 95 degree hip screw -and -plate device.
 Postoperatively the patient is allowed partial weightbearing (with crutches)
until union is secure.
Complications
 Malunion Varus and rotational malunions are fairly common.
 Non -union This occurs in about 5 per cent of cases .

THANK YOU Dr. Jamal Al -Saidy M.B.Ch.B. .F.I.C.M.S


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