Jan 04, 2016 lecture 4 of 4 on proximal femur fractures adapted from ota lecture series. Thirtysix patients with unstable intertrochanteric femoral fractures and. Treatment of intertrochanteric hip fractures in elderly. Pdf the treatment of intertrochanteric fractures of the. Pdf femoral neck fracture following intertrochanteric. There is a greater trochanter on the outside and a lesser trochanter on the opposite side.
The intertrochanteric aspect of the femur is located between the greater and lesser. Hip fracture rehabilitation protocol outpatient or subacute physical therapyphase i weeks 16 postop patient is evaluated weekly in outpatient pt unless deemed otherwise, or in inpatient setting goals. Reverse obliquity fractures are best treated as subtrochanteric fractures with either a 95 degree fixed angle implant or an intramedullary device ipsilateral fracture of the femoral shaft, although more common in association with femoral neck fractures, should be. Full weight bearing, harris score of hip joint, complication. Randomized clinical trials rcts to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from cochrane library up to january 2018, cnki china national knowledge infrastructure, wanfang data, pubmed, and embase. Helpful instruments for reducing proximal femur fractures include schanz screws and thandle, balltipped pusher, and larger pointed reduction forceps.
Operative treatment is complicated further by the need for extensive surgical exposure. Fractures of the femur distal to the lesser trochanter are less common than the femoral neck and intertrochanteric fractures. Introduction the trochanteric area of the femur is the region of the femoral metaphysis between the base of the femoral neck and the most distal level of the lesser trochanter. Rashid s, dar g, kangoo ka, halwai ma 2008 external fixation in the management of intertrochanteric fractures in elderly high risk patients. Compression hip screws are best used in stable fracture patterns and are associated with low rates of complications when properly positioned within the center of the femoral head. Proximal femoral fractures per and intertrochanteric hip. There are several subtypes of fractures which require different.
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. Concomitant ipsilateral subcapital and intertrochanteric. Nailing for trochanteric fracture, intertrochanteric. Hip replacement as alternative to intramedullary nail in. Proximal femur nail in intertrochanteric fractures. Nail or plate fixation of intertrochanteric hip fractures. Patients with femoral neck and intertrochanteric fractures. These fractures are called intertronchanteric hip fractures. Treatment by modified medial displacement and valgus osteotomy. Create healthcare diagrams like this example called evans classification of intertrochanteric fractures in minutes with smartdraw. 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. To access free multiple choice questions on this topic, click here.
What makes an intertrochanteric fracture unstable in 2015. It is therefore important that the treatment methods are effective and have a minimal risk of complications. The present study was undertaken to assess outcome of 50 patients. We advocate fixation of 31a1 fractures with a sliding hip screw and all others with an intramedullary device. Pdf management of intertrochanteric fractures with short. A hip fracture is a break that occurs in the upper part of the femur thigh bone. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone.
It varies in time before it becomes visible on an xray. One of the most common surgical treatments for this type of hip fracture is an open reduction and internal fixation orif. Kyle key points the treatment of intertrochanteric femur fractures is nearly always operative. Comparing the intramedullary nail and extramedullary. This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic. Intertrochanteric fractures of the femur slideshare.
For the first time in my life i feel that i am not alone trying to surpass my bulimia. Intertan and pfn are currently good options in the treatment of unstable intertrochanteric femoral fractures and sustain enough stability during healing period in mobile patients. Doctor answers on symptoms, diagnosis, treatment, and more. Intertrochanteric fractures are defined as extracapsular fractures of the. Two techniques for unstable intertrochanteric femoral fracture. Intertrochanteric fracture definition of intertrochanteric.
Valgus intertrochanteric osteotomy for femoral neck nonunion. Kanchana registrar in surgery teaching hospital peradeniya 2. Intertrochanteric hip fractures occur outside of the joint. Evans classification of intertrochanteric fractures. Methods fiftyfour operated cases of twopart intertrochanteric ao 31a1 were analysed and divided into. Extracapsular fractures of the proximal femur between the greater and lesser trochanters. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. Pdf comparision of pfn and intertan nail for unstable. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. 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. Surgical treatment of type 31a1 twopart intertrochanteric. The intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Femoral neck fractures may proceed to nonunion due to a suboptimal healing environment experiencing high shear forces. Valgus intertrochanteric osteotomy for femoral neck.
A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Introduction unstable intertrochanteric femoral fracture, such as comminuted fracture and wedge fracture, often occur in. There are approximately 150,000 intertrochanteric fractures annually in the united states with an annual incidence of 63 and 34 per 100,000 population per year for elderly females and males, respectively. Intertrochanteric femur fracture statpearls ncbi bookshelf. Jan 02, 2017 intertrochanteric fractures of femur 1. Intertrochanteric fractures of the hip are one of the most common fractures in elder osteoporotic patients, and usually treated by internal fixation. Comparison of complications and functional results of. Intertrochanteric definition of intertrochanteric by.
An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to be adequate reduction and internal fixation. A valgus intertrochanteric osteotomy corrects varus collapse and reorients a vertical fracture with a high pauwels angle. This system is based on the fracture pattern and the ability to obtain a stable reduction. Unusual mode of failure of intertrochanteric femur fracture. The boyd and griffin scale was the first system to attempt to classify these fractures but since simpler evans and ao classifications have also been proposed. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. All fractures were unstable, 22 of them of the type 31a2 prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur.
Intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Pdf nonunion of intertrochanteric fractures of the femur. Intertrochanteric fractures are a common injury of the proximal femur, and are classed as an extracapsular femoral neck fracture. Valgus intertrochanteric osteotomy is an effective method of treating femoral neck nonunion by reducing shear forces at the fracture and correcting the neckshaft angle. In most cases, surgery is recommended because this fracture can take a long time to heal on its own. The most frequent mode of failure is screw cutout through the head. Intertrochanteric neck and head hip fractures fractures examples of treatment 31a. The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of. These hip fractures are usually the result of a fall and often are the hardest type of fracture to treat.
Of the various fracture patterns, intertrochanteric injuries have the lowest rate of complications. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw. A prospective, comparative study was done over a period of 3 years to compare the complications and functional results of two treatment modalities of unstable intertrochanteric fractures of the femur in the elderly. Video lecture with narrations and live annotations from. We describe a modification of the medial displacement and valgus osteotomy of dimon and hughston 1967 which we used in seven fractures, six of which united within 16 weeks. Depending on when this happened would help explain the findings. Good outcomes have been reported in the literature. Femoral hip fractures are a common occurrence in the elderly. Intertrochanteric fracture is one of the most common fractures suffered by elderly patients, and its incidence has been increasing yearly 1, 2. Top 21 on intertrochanteric fracture pathophysiology. Subtrochanteric and intertrochanteric treatment with plate orif peritrochanteric femur fractures extracapsular hip fractures involving the trochanter and frequent extension into the subtrochanteric region evaluate for pathologic fracture if radiographs or medical history indicate incidence elder patient population. The increase of age is related to the increase of the incidence of hip fracture, which is the most frequent cause of hospitalization in centenarians, overcoming congestive heart failure and respiratory infection. Aug 17, 2017 intertrochanteric fracture of the femur. Another metaanalysis recommend the intramedullary nail technique for the treatment of unstable femoral intertrochanteric fractures due to better functional outcomes and.
These fragility hip fractures occur in a characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of falls. A 36yearold caucasian man was admitted with this rare fracture combination, and. Controlled study on gamma nail and proximal femoral locking plate. Intertrochanteric hip fractures are among the most common types of fractures, and the numbers are increasing as the population ages.
The lesser trochanter is an attachment point for one of the major muscles of the hip. Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. Intertrochanteric it femur fractures comprise approximately. Fractures of the intertrochanteric region are most commonly occurring fractures of proximal femur. Callus is what we look for to show signs of healing. Age is the most dominant factor in hip fracture injuries, with most cases occurring in people over 75. Stress fracture, left femur, initial encounter for. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. An xray of the right hip reveals an intertrochanteric fracture a fracture between the greater and lesser trochanter of the femur. The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. Various modes of failure in an operated case of itf fracture have been described. Most intertrochanteric fractures are treated surgically. Barton tm, gleeson r, topliss c, greenwood r, harries wj, chesser tj.
What is the anatomy relative to intertrochanteric hip fractures. An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to. Intertrochanteric fractures account for nearly 50% of all fractures of the proximal femur. Nonunion of intertrochanteric fractures is uncommon but its effects are disabling.
Failure of fixation of trochanteric femur fractures. The primary care provider calls for an orthopedic consultation. Add the power of cambridge dictionary to your website using our free search box widgets. Treatment options include revision operative fixation with grafting, proximal femur osteotomy, and arthroplasty in elderly patients. Treatment of intertrochanteric fractures of the femur. Intertrochanteric fracture is one of the most common fractures of the hip especially in the elderly with porotic bones, usually due to lowenergy trauma like simple falls. 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. The recovery program is giving me the chance that i was seeking to change my life and to free me of the bulimia.
Detailed step by step desription of nailing for trochanteric fracture, intertrochanteric located in our module on proximal femur. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. Ihle on intertrochanteric fracture pathophysiology. Flow diagram demonstrating methods for identification of studies to assess the treatment of osteoporotic intertrochanteric femur fractures aoota type 3. How are intertrochanteric hip fractures classified. Scott ih 1957 treatment of intertrochanteric fractures by skeletal pinning and external. Owing to the good blood supply in intertrochanteric femur fractures, conservative treatment is possible because of the low incidence of nonunion and avascular necrosis, but the complications of immobilization in elderly patients lead to increased mortality and morbidity up to 60% with conservative treatment 1, 2. He recognized that extracapsular fractures united, whereas intracapsular fractures did not. Treatment of intertrochanteric fractures of the femur pdf. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary. Intramedullary fixation using different types of nails is commonly preferred. Intracapsular fractures of the femoral neck per and.
Safe ambulation with or without assistive device, with min to no assist. Intraarticular fractures of the distal radius malone classification. The method provides good initial stability, a source of cancellous bone graft, good postoperative. 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. Intertrochanteric hip fractures clinical presentation. Avascular necrosis and related complications following. 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 fracture rehabilitation protocol heywood ortho.
Moderate evidence supports the use of either a sliding hip screw or a cephalomedullary device in patients with stable intertrochanteric fractures. The treatment of intertrochanteric fractures of the femur with endovis nail. Femoral neck fracture following intertrochanteric fracture. A comparison of the long gamma nail with the sliding hip. Femoral head fractures femoral neck fractures intertrochanteric fractures subtrochanteric. 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. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. Intertrochanteric femur fractures orthopaedicsone articles.
The 31a3 fracture accounted for 5% of all intertrochanteric and subtrochanteric fractures. Occurrence of mechanical failure is rare and usually involves the shaft of the plate. However, in cases with free bone fragments in the greater trochanter. No osteoporotic changes to the bone are seen on xray. Proximal femur fractures 4 intertrochanteric hip fractures. What is the anatomy relative to intertrochanteric hip. Apr 21, 2020 treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. 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. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. Unsp fracture of shaft of right femur, init for clos fx. Inclusion criteria were intertrochanteric femur fracture with long intramedullary nail imn fixation and age equal to or older than 18 years.
Classification of intertrochanteric hip fractures is based on a system introduced by evans in 1949. Nondisplaced intertrochanteric fracture of unspecified femur, initial encounter for open fracture type i or ii. Treatment of unstable intertrochanteric fractures with. Stable intertrochanteric fractures aoota type 31a1 can be successfully treated with conventional implants such as dynamic hip screws dhss and proximal femoral nails pfns. Total hip arthroplasty for intertrochanteric fracture. The most common treatment for intertrochanteric fractures is surgery. Intertrochanteric it fractures are one of the most common types of fracture, with a growing incidence subsequent to increasing longevity of the population.
Top 21 on intertrochanteric fracture pathophysiology healthtap. The femoral neck is the most common location for a hip fracture. Fracture classification the proximal femoral fractures are classified as 31 fractures. Introduction the implant of choice for twopart intertrochanteric femur fracture is still under debate.
Among elderly hip fracture patients, intertrochanteric fracture accounts for more than 6070% of cases with an annual mortality rate of 1520% 3,4,5. The goals of treatment include a predictable union, unrestricted early weight bearing, and. Classification fractures in these regions can be classified as. The dynamic hip screw fixation is a commonly used modality of treatment for intertrochanteric femur itf fractures. Smartdraw includes s of professional healthcare and anatomy chart templates that you can modify and make your own. Evidence from two or more moderate strength studies with consistent findings, or evidence. This study was done to compare the operative parameters and functional outcome of twopart intertrochanteric fractures treated by dynamic hip screw dhs and proximal femur nail pfn. Nov 12, 2019 the involved patients were collected from the clinics database based on a computer query of current procedural terminology cpt codes for trochanteric fractures. Apr 21, 2020 the intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Intertan nail versus proximal femoral nail antirotationasia. Like the intertrochanteric fracture, these injuries often occur with significant comminution.
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