Subtrochanteric FracturesDr. 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 :-
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
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
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.
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.
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