Intertrochanteric fractures are common fractures of the proximal femur at the level of the greater and lesser trochanter.
the sudden onset of hip pain, either before or following a fall,
and the inability to walk,
The injured leg may be shortened and externally rotated if the fracture is displaced.
intertrochanteric fractures are extracapsular and significant ecchymosis may be present,
Plain radiographs of the hip, including an anterior-posterior view with maximal internal rotation and a lateral view, should be obtained in all patients with a suspected hip fracture.
Comparison with the uninvolved hip can be helpful and therefore an anteroposterior pelvis radiograph is frequently obtained.
Intertrochanteric fractures can be classified as stable or unstable fractures .
In stable fractures, the lesser trochanter is not displaced,
there is no comminution.
In unstable fractures, displacement occurs, comminution is present, or multiple fracture lines exist.
If plain radiographs are unrevealing but pain is significant and clinical suspicion is high or the patient is at high risk, an MRI is needed.
In patients with a contraindication to MRI, such as a pacemaker, or if MRI is not available, CT scan is useful.
Treatment.
Patients with hip fracture are at high risk of venous thromboembolism.
Your doctor may prescribe medications to prevent blood clots,
relieve pain
and treat any infection that may be present.
Non-operative management for these fractures is rarely the treatment course.
It is only potentially useful for non-ambulatory, comfort care,
or extremely high-risk patients.
or at the end stage of a terminal illness.
Conservative treatment involves avoiding stress on the fracture,
typically, through consistent bed rest with the afflicted leg in a special position.
After some time of conservative healing, the leg can be mobilized with physiotherapy.
The goal of operative treatment is to quickly stabilize the fracture and spare the often older patient long periods of complete immobility.
We perform hip fracture surgery within 24 hours of hospitalization for patients who are medically stable
and without significant comorbid illness.
Whenever possible, surgery should not be delayed beyond 72 hours.
The type of surgery generally depends on where and how severe the fracture is, whether the fracture is stable or not.
There are many options available for internal fixation of intertrochanteric fractures like dynamic hip screw (DHS).
This surgical method is employed for stable fractures.
and involves reposition the broken bones into their normal position followed by fixation utilizing a sliding hip screw coupled to a side metal plate that is screwed to the femoral shaft.
angled blade plates.
fixation of the Intertrochanteric fractures with a blade plate is superior to fixation with a standard sliding hip screw in an unstable fracture.
The angled blade plate is a single piece - a fixed-angle device with a U-shaped blade
and side plate secured the femoral shaft with screws.
Some consider blade plates to be relatively technically demanding to place,
but with good outcomes in experienced hands.
Although they continue to be used, in many centers they have been superseded by intramedullary nails.
Intramedullary nailing using GAMMA nail or proximal femoral nail (PFN):
This surgical method is employed for unstable fractures
and involves placing an intramedullary nail into the central canal of the femur passing across the fracture site.
Both ends of the intramedullary nail are secured to the bone with screws.
Hip arthroplasty.
it is indicated for severe unstable fractures.
failed fracture fixation surgery.
or osteoporotic bone that is unlikely to hold internal fixation.
During hip arthroplasty, a section or all of the hip joint is replaced with artificial components.
In partial hip arthroplasty, your surgeon replaces only the broken upper portion of the femur.
In total hip arthroplasty, both the broken upper part and the hip socket are replaced.
Deep venous thrombosis prophylaxis should be started during the perioperative period
and continued for 4 to 6 weeks postoperatively.
With the support of experienced physiotherapists,
patients will therefore already sit on the edge of the bed and be mobilized the first day after surgery.
post-operation partial weight bearing using crutches or walker for up to 6 weeks.
With a hip replacement, the patient can already place weight on the leg the day after surgery.
Physical therapy will help to restore normal muscle strength.
You may spend three to six months or longer working with a physical therapist.
Some people make a full recovery and return to normal activities after several months.
Make sure you follow all of your doctor’s instructions and take the required medications to improve your recovery.
Prognosis.
The death rate within one year of fractured neck of femur is typically reported as between 15% and 30%.
with the highest risk (85%) at one year with non-operative treatment.