In view of the comorbidities, it was a practice to manage these patients on traction and delaying surgery. 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. A hip fracture is a break that occurs in the upper part of the femur thigh bone. The purpose of this study is to evaluate intertrochanteric femoral fractures. Fractures of the intertrochanteric region are most commonly occurring fractures of proximal femur. 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. The intramedullary nail is placed in the marrow canal of the fractured extremity to correct the fracture. Handout english intertrochanteric femoral fractures nlogo.
These are distinctive fracture configurations with the femoral shaft having a striking tendency toward medial displacement. An intertrochanteric hip fracture occurs three to four inches from the hip joint. Intertrochanteric femoral fractures are frequent injuries in the elderly, mainly due to falling from a standing position 1. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. Earlier results with gamma nail did not produce any sig. Role of proximal femoral nail in the treatment of unstable. There are several subtypes of fractures which require different treatments and different implants for fixation.
The treatment of intertrochanteric fractures of the femur with endovis nail. Complications and failures in the operative treatment of intertrochanteric fractures of the femur. Evaluation of gamma nails in intertrochanteric fractures of. Local postoperative complications after surgery for. These fractures are common among older adults and can be related to osteoporosis. 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%.
Review article comparisons of internal fixation treatments. A 78year old female patient sustained an intertrochanteric fracture due to slip down a. He recognized that extracapsular fractures united, whereas intracapsular fractures did not. Apr 05, 2015 intertrochanteric fracture classification by kyle 7. Biomechanical study of reduction quality and effects of the medial.
Femoral intertrochanteric fractures are com mon among elderly people, accounting for about 50% of hip fractures. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. An instructional course lecture, american academy of orthopaedic surgeons. The imperative goals of treatment are early mobilization by means of stable fixation using as minimally invasive a procedure as possible. Nail or plate fixation of intertrochanteric hip fractures. The more distal the fracture, the more difficult it is to treat. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. This type of fracture is primarily repaired using an intramedullary nail.
The intramedullary nail is placed in the marrow canal of the fractured extremity to correct the fracture and strengthen the bone. This allows you to put weight on it right after surgery. It is also associated with a high rate of morbidity and mortality 2. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Reverse oblique or transverse fracture pattern intertrochanteric with subtrochanteric extension. Most of these fractures occur in patients older than 65 years, and the fractures are more common in women 3 of every 4 fractures. Intracapsular femoral head or neck and extracapsular intertrochanteric and trochanteric. Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks. Proximal femur nail in intertrochanteric fractures. Pdf femoral neck fracture following intertrochanteric.
The optimal choice of implant addresses the stability of the fracture and affects the outcome. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. Intertrochanteric fractures of the hip are one of the most common fractures in elder osteoporotic patients, and usually treated by internal fixation. 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. Treatment of unstable intertrochanteric fractures with. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Intertrochanteric hip fractures,if minimally displaced, can be repaired by a number of fixation methods. The surgeon should endeavor to distinguish the subtrochanteric femoral fracture from the intertrochanteric fracture since the 5 screwplate cannot adequately stabilize many subtrochanteric. The left column is the information as given during the. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. 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. An intertrochanteric fracture is a common hip fracture that happens most often in older adults. An intertrochanteric fracture is a specific type of hip fracture.
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. 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. Intertrochanteric femur fractures treated with a cmn january 2016 to december 2018 were retrospectively identified. Intertrochanteric hip fractures have become increasingly common, most frequently occurring in older adults. Intertrochanteric fracture classification by kyle 7. Femoral neck fracture following intertrochanteric fracture. Treatment of intertrochanteric hip fractures in elderly. The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly persons with osteoporosis. Intertrochanteric fractures archives trauma international.
Based on her radiograph, our patient has an inter trochanteric fracture. The treatment of intertrochanteric fractures of the femur with endovis nail article pdf available december 2011 with 337 reads how we measure reads. Pugh wl 1955 a selfadjusting nailplate for fractures about the hip joint. 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. Early operation on patients with a hip fracture improved the ability to return to independent living. A doubleblind, prospective, randomised, controlled clinical. There is a greater trochanter on the outside and a lesser trochanter on the opposite side. 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. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. 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.
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. Femur fractures occur with a variety of mechanisms and are based on the specific location of fracture. Avascular necrosis of the femoral head occurs frequently 20% in intracapsular hip fractures, because the blood supply is interrupted. Intertrochanteric fracture postoperative weightbearing 8439 int j clin exp med 2017. 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. A femoral neck fracture occurs one to two inches from the hip joint. A doubleblind, prospective, randomised, controlled. Any information contained in this pdf file is automatically generated from digital material.
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. 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. Trochanteric fractures of the femur treated by the vitallium mclaughlin nail and plate. Short term analysis of the functional and radiological outcome of distal femoral fractures fixed. 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. 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. 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.
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. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Some hip fractures occur below the femoral neck in the area called the intertrochanteric region. Treatment of intertrochanteric fractures of the femur. Simulated postoperative weightbearing after fixation of a severe.
Intertrochanteric fractures are becom ing increasingly common as our popu lation ages. Technical difficulties and results in trochanteric fractures 235. These fractures typically occur in frail patients with multiple medical comorbidities and often result in the end of the patients functional independence. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw. Patient is english speaking return to top exclusion criteria. Gamma nails, intertrochanteric, femur, removal subject areas. Open reduction internal fixation orif with intra or extramedullary implants is the most frequent attitude in these fractures, which usually heal easily. Postoperative weight bearing after a fracture of the femoral neck or an intertrochanteric fracture. Pdf the treatment of intertrochanteric fractures of the.
The prevention of deformity in intertrochanteric fractures. Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. The management of intertrochanteric hip fractures sciencedirect. Comparisons of internal fixation treatments for femoral intertrochanteric fractures. Fracture neck of femur is associated with high mortality in geriatric age group 2035% within the first year of injury. Academic level i trauma center, southeastern us patientsparticipants. 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. Galen originally applied this term to the head of the femur because it resembled a wheel as it turned in the acetabular socket. A 36yearold caucasian man was admitted with this rare fracture combination, and. Trochanteric hip fracture patients were retrieved via a territorywide. Ipsilateral proximal femur fracture femoral neck, intertrochanteric, subtrochanteric 3. Comparing the intramedullary nail and extramedullary.
Between 3540% of these fractures are classified as unstable aoasif classification. Scott ih 1957 treatment of intertrochanteric fractures by skeletal pinning and external fixation. Many systems of classification, such as the evans system, have been used to describe intertrochanteric hip fractures. Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Proximal femur fractures are associated with 22% allcause mortality at 30 days and 36% at one year. Aug 17, 2017 intertrochanteric fracture of the femur. Reason and treatment of failure of proximal femoral nail. Intertrochanteric fractures are defined as extracapsular fractures of the proximal. Orif for hip fractures inr should be reversed to hip fracture surgery. According to harris hip scores evaluation system, 26 patients 28% reached an excellent result, 37 good 41%, 18 poor 20%. 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. Incidence and economic burden of intertrochanteric fracture. 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.
Intertrochanteric definition of intertrochanteric by. It usually requires surgery and months of physical therapy. Introduction intertrochanteric fractures of femur iff that comprise 8% 10% of all fractures are most commonly seen in people over 65 years old 1. Between march 1, 2005, and july 31, 2006, 100 consecutive patients with an intertrochanteric fracture were treated with a new trochanteric antegrade nail intertan. Occult intertrochanteric extension in isolated greater.
Also with limited access approach, one can reduce the blood loss, soft tissue trauma and infection. 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. Feb 06, 2020 the stability score of the intramedullary nailed intertrochanteric fractures. The most common causes of intertrochanteric femur fractures in this population correspondingauthor. Intertrochanteric fracture definition of intertrochanteric. These are highly unstable fractures comprising approximately 5% of all the intertrochanteric and subtrochanteric fractures.
This suggests that incomplete, undiagnosed intertrochanteric. Treatment of recent trochanteric fracture in adults. Original article simulated postoperative weightbearing after. Intramedullary fixation using different types of nails is commonly preferred. Original article biomechanical comparison of dynamic hip. Jul 25, 2015 according to aoota alphanumeric classification intertrochanteric fractures type 31a bone femur 3,segment proximal 1,type a1, a2, a3 a1. Finite element analysis, intertrochanteric fracture, comparative study introduction fractures of the hip are common injuries. However, most systems lack reliability and, in general, intertrochanteric fractures can be divided into two categories.
Classifications of intertrochanteric fractures and their. 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. Several implants have been developed and the surgeon today has many options for fracture fixation. 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. Theyre the points where the muscles of the thigh and hip attach. The management of these fractures requires a prompt surgical fixation allowing early mobilization of the patient. 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. Concomitant ipsilateral subcapital and intertrochanteric. Download full thesis topics for ms dnb orthopaedics degree. Intertrochanteric hip fractures represent one of the most common fracture type encountered in orthopaedic clinical practice. Fracture of the femoral diaphysis amenable to intramedullary nail fixation 3.
Desjardins al, roy a, paiement g, newman n, pedlow f, desloges d, et al. These fractures are called intertronchanteric hip fractures. However, there is limited information regarding the direct economic burden of intertrochanteric fracture and there are no recent direct. Stable intertrochanteric fractures aoota type 31a1 can be successfully treated with conventional implants such as dynamic hip screws dhss and proximal femoral nails pfns.
Intertrochanteric femur fracture statpearls ncbi bookshelf. Intertrochanteric femur fractures orthopaedicsone articles. And approximately 50% of hip fractures occur in the intertrochanteric region, the prevalence of which increases exponentially with age 1. Managing perioperative risk in the hip fracture patient. What makes an intertrochanteric fracture unstable in 2015. 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. The 31a1 fracture is a simple stable trochanteric fracture.
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