Intertrochanteric and Subtrochanteric and Femur Shaft Fractures

Intertrochanteric, Subtrochanteric &Femur Shaft Fracures

Dr. Wahby Ghalib CABMS FJMC MRCS

Intertrochanteric Fractures

Predisposition
Osteoporosis

Mechanism

Fall on greater trochanter twisting


CF
Elderly Can not stand Leg short & externally rotated

XR
# runs from greater to lesser trochanter



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Figure 1 Evans' classificationType I: Undisplaced 2-fragment fractureType II: Displaced 2-fragment fractureType III: 3-fragment fracture without posterolateral support, owing to displacement of greater trochanter fragmentType IV: 3-fragment fracture without medial support, owing to displaced lesser trochanter or femoral arch fragmentType V: 4-fragment fracture without posterolateral and medial support (combination of Type III and Type IV)R: Reversed obliquity fracture

Classification (Evans)

Stable Unstable

Unstable #

> 2 pieces Reverse oblique Subtrochanteric extension


Rx
Early IF

Complications of prolonged immobilization

DVT PE Bed sores Pneumonia UTI hypercalcaemia

Mortality rate of hip #

30 % die in the 1st year



Cx
AVN & NU are not common Malunion

Subtrochanteric #

Within 5cm from lesser trochanter

Young : hi energy trauma Elderly : osteoporosis

CF
Can not stand Leg short & externally rotated


Rx

ORIF

Femur Shaft #

Femur is the longest largest & strongest bone

It is # of young : RTA FFH Elderly : pathologic until proved otherwise Child : may be battered baby


CF
Blood loss : 1-2 L Look for other #s 10 % : there is FN #


Rx
Early stabilization to prevent systemic cx : ARDS MOF PE fat embolism


Rx
<6yr  nonoperative6-10yr  controversial>10yr  operative

Nonoperative Rx

Traction 2-4 w  hip spica 6-12 w


Operative Rx
Plate & screws IMN EF in open #

Objectives :

Stressing the importance of hip fractures taking into account their high incidence and significant mortality and morbidity. Stressing the significance of systemic complications of femur shaft fractures.

Objectives :

Stressing the importance of medical perioperative care of victims of hip fractures being elderly with multiple medical conditions. Understanding the basic principles of management hip fractures. Understanding the importance of prevention and treatment of osteoporosis in hip fractures.