However, in cases with free bone fragments in the greater trochanter. Hip fracture rehabilitation protocol heywood ortho. The intertrochanteric aspect of the femur is located between the greater and lesser. 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. These fragility hip fractures occur in a characteristic population with risk factors including increasing age, female gender, osteoporosis, a history of falls. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. Kanchana registrar in surgery teaching hospital peradeniya 2. Scott ih 1957 treatment of intertrochanteric fractures by skeletal pinning and external. Femoral head fractures femoral neck fractures intertrochanteric fractures subtrochanteric. The femoral neck is the most common location for a hip fracture.
The method provides good initial stability, a source of cancellous bone graft, good postoperative. Surgical treatment of type 31a1 twopart intertrochanteric. Pdf the treatment of intertrochanteric fractures of the. Create healthcare diagrams like this example called evans classification of intertrochanteric fractures in minutes with smartdraw. Various modes of failure in an operated case of itf fracture have been described. 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. Another metaanalysis recommend the intramedullary nail technique for the treatment of unstable femoral intertrochanteric fractures due to better functional outcomes and.
The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Good outcomes have been reported in the literature. Avascular necrosis and related complications following. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary. Comparison of complications and functional results of.
The recovery program is giving me the chance that i was seeking to change my life and to free me of the bulimia. Apr 21, 2020 the intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Jan 04, 2016 lecture 4 of 4 on proximal femur fractures adapted from ota lecture series. Intertrochanteric fractures of the hip are one of the most common fractures in elder osteoporotic patients, and usually treated by internal fixation. Femoral neck fracture following intertrochanteric fracture. What is the anatomy relative to intertrochanteric hip fractures. Patients with femoral neck and intertrochanteric fractures. 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. An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks. The dynamic hip screw fixation is a commonly used modality of treatment for intertrochanteric femur itf fractures. Pdf nonunion of intertrochanteric fractures of the femur. Intracapsular fractures of the femoral neck per and. It is therefore important that the treatment methods are effective and have a minimal risk of complications.
Intertrochanteric fractures account for nearly 50% of all fractures of the proximal femur. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. The present study was undertaken to assess outcome of 50 patients. 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.
Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. Nailing for trochanteric fracture, intertrochanteric. Intertrochanteric femur fracture statpearls ncbi bookshelf. 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.
Add the power of cambridge dictionary to your website using our free search box widgets. Treatment of unstable intertrochanteric fractures with. 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. Aug 17, 2017 intertrochanteric fracture of the femur. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. Just like the intertrochanteric crest on the posterior side of the femoral head, the intertrochanteric line marks the transition between the femoral neck and shaft.
Femoral hip fractures are a common occurrence in the elderly. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. Intramedullary fixation using different types of nails is commonly preferred. 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. Top 21 on intertrochanteric fracture pathophysiology. Intertrochanteric hip fractures are among the most common types of fractures, and the numbers are increasing as the population ages. Treatment of intertrochanteric fractures of the femur pdf. One of the most common surgical treatments for this type of hip fracture is an open reduction and internal fixation orif. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Of the various fracture patterns, intertrochanteric injuries have the lowest rate of complications. The goals of treatment include a predictable union, unrestricted early weight bearing, and. A valgus intertrochanteric osteotomy corrects varus collapse and reorients a vertical fracture with a high pauwels angle. The primary care provider calls for an orthopedic consultation. Concomitant ipsilateral subcapital and intertrochanteric.
Intertrochanteric it femur fractures comprise approximately. Classification fractures in these regions can be classified as. There is a greater trochanter on the outside and a lesser trochanter on the opposite side. Evans classification of intertrochanteric fractures. Controlled study on gamma nail and proximal femoral locking plate. The intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Callus is what we look for to show signs of healing. Two techniques for unstable intertrochanteric femoral fracture.
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. Fracture classification the proximal femoral fractures are classified as 31 fractures. 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 are a common injury of the proximal femur, and are classed as an extracapsular femoral neck fracture. Total hip arthroplasty for intertrochanteric fracture. Safe ambulation with or without assistive device, with min to no assist. Treatment of intertrochanteric fractures of the femur. This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. 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. These fractures are called intertronchanteric hip fractures.
Intertrochanteric fractures of the femur slideshare. To access free multiple choice questions on this topic, click here. 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. Valgus intertrochanteric osteotomy for femoral neck nonunion.
Intertrochanteric femur fractures orthopaedicsone articles. The lesser trochanter is an attachment point for one of the major muscles of the hip. Unsp fracture of shaft of right femur, init for clos fx. Intertrochanteric fracture definition of intertrochanteric. 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. Nonunion of intertrochanteric fractures is uncommon but its effects are disabling. Flow diagram demonstrating methods for identification of studies to assess the treatment of osteoporotic intertrochanteric femur fractures aoota type 3. Pdf management of intertrochanteric fractures with short. Top 21 on intertrochanteric fracture pathophysiology healthtap. Unusual mode of failure of intertrochanteric femur fracture.
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. Failure of fixation of trochanteric femur fractures. Treatment of intertrochanteric hip fractures in elderly. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic. Intertrochanteric fracture is one of the most common fractures suffered by elderly patients, and its incidence has been increasing yearly 1, 2. Stress fracture, left femur, initial encounter for. Video lecture with narrations and live annotations from. 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. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. Extracapsular fractures of the proximal femur between the greater and lesser trochanters. 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. 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. No osteoporotic changes to the bone are seen on xray.
Intertrochanteric hip fractures clinical presentation. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Proximal femur fractures 4 intertrochanteric hip fractures. 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 definition of intertrochanteric by. Moderate evidence supports the use of either a sliding hip screw or a cephalomedullary device in patients with stable intertrochanteric fractures. The most frequent mode of failure is screw cutout through the head. Fractures of the femur distal to the lesser trochanter are less common than the femoral neck and intertrochanteric fractures. Intraarticular fractures of the distal radius malone classification. 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. Like the intertrochanteric fracture, these injuries often occur with significant comminution. Jan 02, 2017 intertrochanteric fractures of femur 1. Among elderly hip fracture patients, intertrochanteric fracture accounts for more than 6070% of cases with an annual mortality rate of 1520% 3,4,5.
There are several subtypes of fractures which require different. Intertrochanteric neck and head hip fractures fractures examples of treatment 31a. What is the anatomy relative to intertrochanteric hip. A hip fracture is a break that occurs in the upper part of the femur thigh bone. An xray of the right hip reveals an intertrochanteric fracture a fracture between the greater and lesser trochanter of the femur. Treatment options include revision operative fixation with grafting, proximal femur osteotomy, and arthroplasty in elderly patients.
The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. 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 most common treatment for intertrochanteric fractures is surgery. We advocate fixation of 31a1 fractures with a sliding hip screw and all others with an intramedullary device. Pdf comparision of pfn and intertan nail for unstable. The 31a3 fracture accounted for 5% of all intertrochanteric and subtrochanteric fractures. Age is the most dominant factor in hip fracture injuries, with most cases occurring in people over 75. 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.
These hip fractures are usually the result of a fall and often are the hardest type of fracture to treat. Detailed step by step desription of nailing for trochanteric fracture, intertrochanteric located in our module on proximal femur. Inclusion criteria were intertrochanteric femur fracture with long intramedullary nail imn fixation and age equal to or older than 18 years. Nail or plate fixation of intertrochanteric hip fractures. 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. 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.
Most intertrochanteric fractures are treated surgically. Fractures of the intertrochanteric region are most commonly occurring fractures of proximal femur. Smartdraw includes s of professional healthcare and anatomy chart templates that you can modify and make your own. Femoral neck fractures may proceed to nonunion due to a suboptimal healing environment experiencing high shear forces. Depending on when this happened would help explain the findings. 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. Treatment by modified medial displacement and valgus osteotomy. Thirtysix patients with unstable intertrochanteric femoral fractures and. Apr 21, 2020 treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Barton tm, gleeson r, topliss c, greenwood r, harries wj, chesser tj. Nondisplaced intertrochanteric fracture of unspecified femur, initial encounter for open fracture type i or ii. Methods fiftyfour operated cases of twopart intertrochanteric ao 31a1 were analysed and divided into.
Valgus intertrochanteric osteotomy for femoral neck. He recognized that extracapsular fractures united, whereas intracapsular fractures did not. Evidence from two or more moderate strength studies with consistent findings, or evidence. What makes an intertrochanteric fracture unstable in 2015. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. A 36yearold caucasian man was admitted with this rare fracture combination, and. This system is based on the fracture pattern and the ability to obtain a stable reduction. Pdf femoral neck fracture following intertrochanteric. Occurrence of mechanical failure is rare and usually involves the shaft of the plate.
Intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Ihle on intertrochanteric fracture pathophysiology. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw. Doctor answers on symptoms, diagnosis, treatment, and more. Valgus intertrochanteric osteotomy is an effective method of treating femoral neck nonunion by reducing shear forces at the fracture and correcting the neckshaft angle. Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. It varies in time before it becomes visible on an xray. Proximal femur nail in intertrochanteric fractures. Stable intertrochanteric fractures aoota type 31a1 can be successfully treated with conventional implants such as dynamic hip screws dhss and proximal femoral nails pfns. Proximal femoral fractures per and intertrochanteric hip. Right femur shaft upper leg bone fracture icd10cm diagnosis code s72. 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.
Intertrochanteric fractures are defined as extracapsular fractures of the. 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. Full weight bearing, harris score of hip joint, complication. Rashid s, dar g, kangoo ka, halwai ma 2008 external fixation in the management of intertrochanteric fractures in elderly high risk patients. For the first time in my life i feel that i am not alone trying to surpass my bulimia. A comparison of the long gamma nail with the sliding hip. Hip replacement as alternative to intramedullary nail in. In most cases, surgery is recommended because this fracture can take a long time to heal on its own. Introduction the implant of choice for twopart intertrochanteric femur fracture is still under debate. How are intertrochanteric hip fractures classified. Intertrochanteric it fractures are one of the most common types of fracture, with a growing incidence subsequent to increasing longevity of the population. Introduction unstable intertrochanteric femoral fracture, such as comminuted fracture and wedge fracture, often occur in. Classification of intertrochanteric hip fractures is based on a system introduced by evans in 1949. Intertan nail versus proximal femoral nail antirotationasia.
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. 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. Comparing the intramedullary nail and extramedullary. Intertrochanteric hip fractures occur outside of the joint. Helpful instruments for reducing proximal femur fractures include schanz screws and thandle, balltipped pusher, and larger pointed reduction forceps. The treatment of intertrochanteric fractures of the femur with endovis nail. Kyle key points the treatment of intertrochanteric femur fractures is nearly always operative. 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.
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