Treatment of intertrochanteric fractures of the femur pdf. Trauma implant options for the treatment of intertrochanteric. What is the anatomy relative to intertrochanteric hip fractures. The study comprised of 40 patients, with a mean age of mean age 77 8. Evans classification of intertrochanteric fractures. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. 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. Theyre the points where the muscles of the thigh and hip attach. Most of these fractures occur in patients older than 65 years, and the fractures are more common in women 3 of every 4 fractures. Intertrochanteric fractures are becom ing increasingly common as our popu lation ages. Nail or plate fixation of intertrochanteric hip fractures. 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.
Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. Valgus intertrochanteric osteotomy for femoral neck nonunion. Spiral fracture of femur in a 3 month old which was the result of nai. Pdf femoral neck fracture following intertrochanteric. A prospective randomised study comparing anatomical reduction and medial displacement osteotomy. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary. Fractures of the proximal femur are classified by anatomical location. Two or three more thread pins were passed in the proximal femur. Various modes of failure in an operated case of itf fracture have been described. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Intertrochanteric femur fracture statpearls ncbi bookshelf. See instructions for authors for a complete description of levels of evidence. Intertrochanteric hip fractures are among the most common types of fractures, and the numbers are increasing as the population ages. These fractures are common among older adults and can be related to osteoporosis.
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. Valgus intertrochanteric osteotomy is an effective method of treating femoral neck nonunion by reducing shear forces at the fracture and correcting the neckshaft angle. When the hip fracture occurs through the neck of the femur and the ball is completely displaced, there. Evaluation and management of an unstable intertrochanteric. Note bucket handle appearance of distal metaphysis above. Two techniques for unstable intertrochanteric femoral fracture. The dynamic hip screw fixation is a commonly used modality of treatment for intertrochanteric femur itf fractures. Treatment of unstable intertrochanteric fractures with. Femur intertrochanteric fracture an overview sciencedirect topics. Incidence and economic burden of intertrochanteric fracture. There are several subtypes of fractures which require different.
Intertrochanteric fractures of the hip are one of the most common fractures in elder osteoporotic patients, and usually treated by internal fixation. 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. Overall the incidence has been estimated to be approximately 1520100,000. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks. It is therefore important that the treatment methods are effective and have a minimal risk of complications. The goals of treatment include a predictable union, unrestricted early weight bearing, and. Intertrochanteric it femur fractures comprise approximately. Oct 28, 2018 the overall incidence rate of fractures of the proximal femur is found to be approximately 230 per 100,000 patients with approximately 510% of these fracture occurring within the st region 1, 2. Femur shaft fractures broken thighbone orthoinfo aaos. Create healthcare diagrams like this example called evans classification of intertrochanteric fractures in minutes with smartdraw. Early operation on patients with a hip fracture improved the ability to return to independent living.
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 fractures account for about 50% of proximal femur fractures egol 2010 female to male ratio is 3. All fractures of the femur in children should be referred to the orthopaedic team. 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. Oct 01, 20 intertrochanteric fractures hip fracture 1. Femoral neck fracture following intertrochanteric fracture. Intertrochanteric hip fractures clinical presentation. Chemical anticoagulation for 30 days minimum after hip fracture most hip fracture surgeries allow weightbearing as tolerated to the affected leg unless there is concurrent injury to the lower extremity without specific range of motion precautions. The incidence of intertrochanteric fractures is gender and racedependent and varies from country to country. Pdf treatment of intertrochanteric fractures by external. 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.
Management of subtrochanteric proximal femur fractures. Intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Intertrochanteric femur fractures are one of the most serious causes of mortality and morbidity in the elderly. Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Fracture classification and instability criteria of intertrochanteric. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. Unstable intertrochanteric fracture of the femur is one of the most commonly encountered orthopaedic injuries in the united states. 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. Intramedullary fixation using different types of nails is commonly preferred. Good outcomes have been reported in the literature. Listen to the audio pronunciation in the cambridge english dictionary.
Fractures of femur requiring urgent orthopaedic referral. Intertrochanteric fractures of femur by proximal femoral. The most frequent mode of failure is screw cutout through the head. Aoota 31a3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared. Fracture classification the proximal femoral fractures are classified as 31 fractures. Treatment of intertrochanteric hip fractures in elderly high. The exception is the anteriolateral approach to the hip, listed below. The femur is the longest and strongest bone in the body, and it takes a great deal of force to break it. Intertrochanteric femur fractures orthopaedicsone articles. The predictors used were the bone mass of the calcaneus and proximal femur, anthropometry, history of fracture family and personal, medication use, functional status, physical activity and visual function. The treatment of intertrochanteric femur fractures is nearly always operative. 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 medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Some of the factors found to be associated with a patient sustaining an intertrochanteric rather than a femoral neck fracture include advancing age, increased number of comorbidities. Furthermore, the biomechanics of hip fracture fixation strategies as. Fracture was fixed with two 5 mm diameter and 2025 cm long thread pin with sharp tip passed from lateral aspect greater trochanter along the neck engaging the subchondral bone of head.
Intertrochanteric fractures of femur wereconsidered for study. The long, straight part of the femur thighbone is called the femoral shaft. The postoperative radiographs demonstrate that the lag screw is superior in the femoral head with a tipapex distance of 40 millimeters. The main outcome measures were femoral neck and intertrochanteric fractures occurring during an average of 8 years of followup. Proximal femur nail in intertrochanteric fractures. Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. Hip fracture represents a substantial economic burden to the u.
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. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the. An intertrochanteric fracture is a specific type of hip fracture. 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. Hip fracture rehabilitation protocol heywood ortho. Jul 25, 2015 according to aoota alphanumeric classification intertrochanteric fractures type 31a bone femur 3,segment proximal 1,type a1, a2, a3 a1. Treatment options for unstable intertrochanteric fractures include intramedullary nail and extramedullary fixation, although evidence regarding the most appropriate treatment for such fractures. The overall incidence rate of fractures of the proximal femur is found to be approximately 230 per 100,000 patients with approximately 510% of these fracture occurring within the st region 1, 2. Some of the factors found to be associated with a patient sustaining an intertrochanteric rather than a femoral neck fracture include advancing age, increased number of. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. There is a greater trochanter on the outside and a. Intertrochanteric fractures of the femur slideshare.
The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap forming the knee joint. Smartdraw includes s of professional healthcare and anatomy chart templates that you can modify and make your own. An association exists between these fractures and the patients comorbidities. Implant options for the treatment of intertrochanteric. Femoral neck fracture intertrochanteric fracture subtrochanteric fracture typically seen in younger patients secondary to traumatic injuries accounting for less than 5 percent of cases in elderly patients.
Safe ambulation with or without assistive device, with min to no assist. 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. Occurrence of mechanical failure is rare and usually involves the shaft of the plate. Proximal femoral fractures per and intertrochanteric hip. Relevant anatomy, classification, and biomechanics. Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration.
He recognized that extracapsular fractures united, whereas intracapsular fractures did not. Surgical treatment of basicervical intertrochanteric. 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. Classifications of intertrochanteric fractures and their.
Resources on intertrochanteric fractures evans classification and related topics in orthopaedicsone spaces. Apr 06, 2020 the intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Transverse fracture with displacement and shortening. Treatment by modified medial displacement and valgus osteotomy. Unusual mode of failure of intertrochanteric femur fracture. Pdf nonunion of intertrochanteric fractures of the femur. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. 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. Patients in the study had evans stable type 1 intertrochanteric fractures and unstable type 1 fractures. Proximal hip fracture open reductioninternal fixation and. The intertrochanteric area of the femur is distal to the femoral neck and proximal to the femoral shaft. Most intertrochanteric fractures are treated surgically. An instructional course lecture, american academy of orthopaedic surgeons.
Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Most of these fractures occur in patients older than 65 years, and the fractures are. Inclusion criteria all patients above 18 years of age with fresh intertrochanteric fractures who were able to walk prior to the fracture were included in the study. Intertrochanteric femur fractures account for approximately 250,000 fractures per year and represent a growing public health concern with the aging population in. Comparing the intramedullary nail and extramedullary fixation.
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