These fractures are called intertronchanteric hip fractures. This type of fracture is primarily repaired using an intramedullary nail. An intertrochanteric hip fracture occurs three to four inches from the hip joint. Comparisons of internal fixation treatments for femoral intertrochanteric fractures. A doubleblind, prospective, randomised, controlled. The more distal the fracture, the more difficult it is to treat. Nonunion, failure of the fracture to heal, is common in fractures of the neck of the femur, but much more rare with other types of hip fracture.
Intertrochanteric fractures are defined as extracapsular fractures of the proximal. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Orif for hip fractures inr should be reversed to hip fracture surgery. Treatment of intertrochanteric hip fractures in elderly. Aug 17, 2017 intertrochanteric fracture of the femur. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Concomitant ipsilateral subcapital and intertrochanteric. The intramedullary nail is placed in the marrow canal of the fractured extremity to correct the fracture. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Desjardins al, roy a, paiement g, newman n, pedlow f, desloges d, et al. Intertrochanteric hip fractures have become increasingly common, most frequently occurring in older adults.
Galen originally applied this term to the head of the femur because it resembled a wheel as it turned in the acetabular socket. Intertrochanteric hip fracture has been reported to be a common type of hip fracture and is known to be associated with older age and multiple comorbidities, suggesting substantial direct healthcare costs 10. Hip fracture update erik t otterberg, md september 27, 2019 incidence second leading cause of hospitalizations in the elderly 390,000 new hip fractures per year predicted to double by 2050 at risk populations elderly. Fracture neck of femur is associated with high mortality in geriatric age group 2035% within the first year of injury. Proximal femur fractures are associated with 22% allcause mortality at 30 days and 36% at one year. In view of the comorbidities, it was a practice to manage these patients on traction and delaying surgery. However, most systems lack reliability and, in general, intertrochanteric fractures can be divided into two categories. These fractures typically occur in frail patients with multiple medical comorbidities and often result in the end of the patients functional independence. Treatment of unstable intertrochanteric fractures with. Also with limited access approach, one can reduce the blood loss, soft tissue trauma and infection. Evaluation of gamma nails in intertrochanteric fractures of. Femoral intertrochanteric fractures are com mon among elderly people, accounting for about 50% of hip fractures.
Incidence and economic burden of intertrochanteric fracture. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Intertrochanteric hip fractures represent one of the most common fracture type encountered in orthopaedic clinical practice. Trochanteric fractures of the femur treated by the vitallium mclaughlin nail and plate. Although closed reduction and compression hip nail fixation trademedics, seongnam, korea was performed, it showed slight varus alignment with engagement of the proximal fragment into the shaft in immediate postoperative radiographs b. These are distinctive fracture configurations with the femoral shaft having a striking tendency toward medial displacement. Treatment of recent trochanteric fracture in adults. Proximal femur nail in intertrochanteric fractures. Intertrochanteric fracture classification by kyle 7. Between 3540% of these fractures are classified as unstable aoasif classification. A doubleblind, prospective, randomised, controlled clinical. The optimal choice of implant addresses the stability of the fracture and affects the outcome. Biomechanical study of reduction quality and effects of the medial. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j.
Evidence from two or more moderate strength studies with consistent findings, or evidence from a single high quality study for recommending for or against the intervention. Complications and failures in the operative treatment of intertrochanteric fractures of the femur. A 36yearold caucasian man was admitted with this rare fracture combination, and. A hip fracture is a break that occurs in the upper part of the femur thigh bone. The management of intertrochanteric hip fractures sciencedirect. Reverse oblique or transverse fracture pattern intertrochanteric with subtrochanteric extension. Postoperative weight bearing after a fracture of the femoral neck or an intertrochanteric fracture. Between march 1, 2005, and july 31, 2006, 100 consecutive patients with an intertrochanteric fracture were treated with a new trochanteric antegrade nail intertan. He recognized that extracapsular fractures united, whereas intracapsular fractures did not. A twopart fracture is very stable because once the two fragments are reduced, they are impacted on each other and provide inherent stability for the implant. A femoral neck fracture occurs one to two inches from the hip joint.
Comparing the intramedullary nail and extramedullary. Intertrochanteric fractures abstract treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. And approximately 50% of hip fractures occur in the intertrochanteric region, the prevalence of which increases exponentially with age 1. Intertrochanteric femoral fractures are frequent injuries in the elderly, mainly due to falling from a standing position 1. Open reduction internal fixation orif with intra or extramedullary implants is the most frequent attitude in these fractures, which usually heal easily.
The surgeon should endeavor to distinguish the subtrochanteric femoral fracture from the intertrochanteric fracture since the 5 screwplate cannot adequately stabilize many subtrochanteric. Femur fractures occur with a variety of mechanisms and are based on the specific location of fracture. What makes an intertrochanteric fracture unstable in 2015. Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Occult intertrochanteric extension in isolated greater. Femoral neck fracture following intertrochanteric fracture. Any information contained in this pdf file is automatically generated from digital material. Feb 06, 2020 the stability of an intertrochanteric fracture is defined by the amount of contact between the proximal and distal main fragments see the images below. An instructional course lecture, american academy of orthopaedic surgeons. These fragility hip fractures occur in a characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities 3. Pdf femoral neck fracture following intertrochanteric. Based on her radiograph, our patient has an inter trochanteric fracture. Nail or plate fixation of intertrochanteric hip fractures. The treatment of intertrochanteric fractures of the femur with endovis nail article pdf available december 2011 with 337 reads how we measure reads.
Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. Scott ih 1957 treatment of intertrochanteric fractures by skeletal pinning and external fixation. Pdf the treatment of intertrochanteric fractures of the. There are several subtypes of fractures which require different treatments and different implants for fixation. Intertrochanteric femur fractures account for approximately 250,000 fractures per year and represent a growing public health concern with the aging population in the united states. Early operation on patients with a hip fracture improved the ability to return to independent living. The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. Femur fractures common injury due to major violent trauma 1 femur fracture 10,000 people more common in people 65 yo femur fracture leads to reduced activity for 107 days, the average length of hospital stay is 25 days motor vehicle, motorcycle, auto pedestrian, aircraft, and gunshot wound accidents are most. Short term analysis of the functional and radiological outcome of distal femoral fractures fixed. Nov 15, 2010 we report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident.
An intertrochanteric fracture is a common hip fracture that happens most often in older adults. It has also been shown that women with a hip fracture have a fivefold increase and men have about an eightfold increase in relative likelihood of death within the first 3. Managing perioperative risk in the hip fracture patient. These are highly unstable fractures comprising approximately 5% of all the intertrochanteric and subtrochanteric fractures. The purpose of this study is to evaluate intertrochanteric femoral fractures.
Handout english intertrochanteric femoral fractures nlogo. Intertrochanteric femur fractures orthopaedicsone articles. The 31a1 fracture is a simple stable trochanteric fracture. Some hip fractures occur below the femoral neck in the area called the intertrochanteric region. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. The otaao type 31 a3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. The most common causes of intertrochanteric femur fractures in this population correspondingauthor. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the femur which forms the hip joint. The intramedullary nail is placed in the marrow canal of the fractured extremity to correct the fracture and strengthen the bone. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. Intertrochanteric fractures are becom ing increasingly common as our popu lation ages. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used. Jul 25, 2015 according to aoota alphanumeric classification intertrochanteric fractures type 31a bone femur 3,segment proximal 1,type a1, a2, a3 a1.
This allows you to put weight on it right after surgery. An intertrochanteric fracture is a specific type of hip fracture. However, there is limited information regarding the direct economic burden of intertrochanteric fracture and there are no recent direct. Ipsilateral proximal femur fracture femoral neck, intertrochanteric, subtrochanteric 3. Introduction intertrochanteric fractures of femur iff that comprise 8% 10% of all fractures are most commonly seen in people over 65 years old 1. Intertrochanteric fractures of the hip are one of the most common fractures in elder osteoporotic patients, and usually treated by internal fixation. A 78year old female patient sustained an intertrochanteric fracture due to slip down a. Intramedullary fixation using different types of nails is commonly preferred. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw. The treatment of intertrochanteric fractures of the femur with endovis nail. Intracapsular femoral head or neck and extracapsular intertrochanteric and trochanteric. The prevention of deformity in intertrochanteric fractures. It is also associated with a high rate of morbidity and mortality 2.
As a consequence, the capsule of the hip joint attaches in the region of the intertrochanteric line on the anterior side, but a finger away from the intertrochanteric crest on the posterior side of the head. Treatment of intertrochanteric fractures of the femur. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. Many systems of classification, such as the evans system, have been used to describe intertrochanteric hip fractures. Feb 06, 2020 the stability score of the intramedullary nailed intertrochanteric fractures. The treatment of intertrochanteric fractures of the hip has evolved along with changes in the design of the implants used to fix them, but there remains conflicting evidence to guide the choice of implant. Technical difficulties and results in trochanteric fractures 235. Original article biomechanical comparison of dynamic hip. Simulated postoperative weightbearing after fixation of a severe. Review article comparisons of internal fixation treatments. Pugh wl 1955 a selfadjusting nailplate for fractures about the hip joint. This suggests that incomplete, undiagnosed intertrochanteric.
It usually requires surgery and months of physical therapy. Role of proximal femoral nail in the treatment of unstable. The term was later transferred to the other adjacent projections at the proximal end of the femur, probably in reference to their attachment site for muscles that produce rotary movements of this bone. Intertrochanteric fracture definition of intertrochanteric. The management of these fractures requires a prompt surgical fixation allowing early mobilization of the patient. A prospective study comparing the functional outcome, radiological outcome and gait analysis between lateral surgical approach and posterior surgical approach in the total hip replacement. Displaced intertrochanteric fracture of right femur, subsequent encounter for open fracture type i or ii with routine healing displ intertroch fx r femr, 7the icd10cm diagnosis code s72. Original article simulated postoperative weightbearing after. Intertrochanteric hip fractures,if minimally displaced, can be repaired by a number of fixation methods. Intertrochanteric neck and head hip fractures fractures examples of treatment 31a with dhs 31b and c with hemiarthroplasty we will further discuss the 31a fractures. Earlier results with gamma nail did not produce any sig. Classifications of intertrochanteric fractures and their. Most of these fractures occur in patients older than 65 years, and the fractures are more common in women 3 of every 4 fractures.
Academic level i trauma center, southeastern us patientsparticipants. Thankfully, these geriatric and osteoporotic femoral fractures can be fixed by intramedullary nails to facilitate an early leaving bed and support a desired functional recovery 2, 3. Intertrochanteric fractures archives trauma international. Reason and treatment of failure of proximal femoral nail.
Intertrochanteric fracture postoperative weightbearing 8439 int j clin exp med 2017. Local postoperative complications after surgery for. Download full thesis topics for ms dnb orthopaedics degree. Trochanteric hip fracture patients were retrieved via a territorywide. Intertrochanteric fractures of the upper femur occur in the region of the femur bounded by the femoral neck and lesser trochanter medially and the greater trochanter laterally.
Jun 22, 2014 cooper described an intertrochanteric fracture in his treatise of 1851 recommended treatment was moderate extension and steady support of the limb in its natural position. Hip fractures are associated with significant morbidity and mortality, and it is reported the 1year mortality after sustaining a hip fracture is estimated to be 14 to 58%. Fracture of the femoral diaphysis amenable to intramedullary nail fixation 3. According to harris hip scores evaluation system, 26 patients 28% reached an excellent result, 37 good 41%, 18 poor 20%. Theyre the points where the muscles of the thigh and hip attach. Patient is english speaking return to top exclusion criteria. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Several implants have been developed and the surgeon today has many options for fracture fixation. Gamma nails, intertrochanteric, femur, removal subject areas. Intertrochanteric definition of intertrochanteric by. Avascular necrosis of the femoral head occurs frequently 20% in intracapsular hip fractures, because the blood supply is interrupted.
Intertrochanteric femur fractures treated with a cmn january 2016 to december 2018 were retrospectively identified. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks. There is a greater trochanter on the outside and a lesser trochanter on the opposite side. Fractures of the intertrochanteric region are most commonly occurring fractures of proximal femur. Intertrochanteric fractures account for approximately 38% to 50% of all hip fractures. Apr 05, 2015 intertrochanteric fracture classification by kyle 7. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. These fractures are common among older adults and can be related to osteoporosis. Stable intertrochanteric fractures aoota type 31a1 can be successfully treated with conventional implants such as dynamic hip screws dhss and proximal femoral nails pfns. The left column is the information as given during the. Finite element analysis, intertrochanteric fracture, comparative study introduction fractures of the hip are common injuries.
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