Proximal femur fractures 4 intertrochanteric hip fractures. Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Primary bipolar arthroplasty in unstable intertrochanteric. 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 it fractures pose a tremendous burden to the healthcare system. Links to pubmed are also available for selected references. 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.
Dec 03, 2019 femoral neck fracture during and frxtura surgery, with special reference to the type of anaesthesia used. One of these complications is break of placed pfn or gamma nail. Bipolar hemiarthroplasty in unstable intertrochanteric. Technique and early results of percutaneous reduction of. Fixation of intertrochanteric femur fractures using. Trochanteric locking nail versus arthroplasty in unstable. Proximal femoral fractures per and intertrochanteric hip. It usually requires surgery and months of physical therapy. Intraarticular fractures of the distal radius malone classification. This procedure requires the placement of a screw and plate, or multiple screws to fix the fracture. Fixation of intertrochanteric fracture with gamma nail. Apr 21, 2020 treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Pfn in it fractures indications indications figure 1 1. A fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction.
The prevention of deformity in intertrochanteric fractures. 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. Evaluation of gamma nails in intertrochanteric fractures of. Rashid s, dar g, kangoo ka, halwai ma 2008 external fixation in the management of intertrochanteric fractures in elderly high risk patients. These fractures primarily are due to bone fragility in the elderly caused by osteoporosis. The effect of hospital type and surgical delay on mortality after surgery for hip fracture.
A 36yearold caucasian man was admitted with this rare fracture combination, and. Use the tiptoapex distance the tiptoapex distance has been described by baumgaertner et al. Proximal femur nail in intertrochanteric fractures. There are several subtypes of fractures which require different. Treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration. A hip fracture is a break that occurs in the upper part of the femur thigh bone. Original article biomechanical evaluation of an improved. Reverse oblique or transverse fracture pattern intertrochanteric with subtrochanteric extension.
Early operation on patients with a hip fracture improved the ability to return to independent living. Treatment of intertrochanteric fractures of the femur. 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. Get a printable copy pdf file of the complete article 9. 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. Galen originally applied this term to the head of the femur because it resembled a wheel as it turned in the acetabular socket. Asa grade, arterial stenting, and anesthesia mode prior to surgery were. Inclusion criteria were intertrochanteric femur fracture with long intramedullary nail imn fixation and age equal to or older than 18 years.
The surgeon should endeavor to distinguish the subtrochanteric femoral fracture from the intertrochanteric fracture since the 5 screwplate cannot adequately stabilize many subtrochanteric. However, internal fixation is often associated with failure in elderly, osteoporotic patients who comprise a significant portion of the affected population. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. Most of these fractures occur in patients older than 65 years, and the fractures are more common in women 3 of every 4 fractures. Comparing the intramedullary nail and extramedullary. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Preoperative cardiac events in elderly patients with hip fracture fratufa to epidural or conventional analgesia. Fractures of the proximal femur are a substantial problem in the elderly. Review article comparisons of internal fixation treatments. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Intertrochanteric fractures generally occur as a result of lowenergy trauma. After reaming the femoral canal, the gamma nail is inserted into the femur with an alignment device. It was studied at ashwini sahakari rugnalaya and sanshodhan kendra solapur india and government medical college chandrapur india from april2015 to december2017 using innovative tro. Kyle key points the treatment of intertrochanteric femur fractures is nearly always operative.
We evaluated operation time, intraoperative blood loss, and. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. The purpose of this prospective study was to evaluate the functional and clinical outcomes of cemented bipolar hemiarthroplasty as a primary treatment for unstable intertrochanteric fractures in elderly patients. Implant options for the treatment of intertrochanteric fractures of the hip. Pdf femoral neck fracture following intertrochanteric. Age is the most dominant factor in hip fracture injuries, with most cases occurring in people over 75. Lower limb clinical and functional outcomes of treatment. Intertrochanteric fractures account for approximately 38% to 50% of all hip fractures. The prevention of deformity in intertrochanteric fractures of the femur.
Reason and treatment of failure of proximal femoral nail. He recognized that extracapsular fractures united, whereas intracapsular fractures did not. Internal fixation with a compression hip screw or cephalomedullary nail is considered the standard of care for most intertrochanteric it proximal femur fractures. Left hip yes no right hip yes no the following will be performed. 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. Intramedullary fixation using different types of nails is commonly preferred. The intertrochanteric proximal femoral fractures account for a signifi cant amount of todayls orthopaedic surgeonls workload and pose a challenge for the. Although consistently good results are obtained while treating stable it fractures, treatment failure rates with unstable fractures are much higher, and hence, it is imperative to identify unstable patterns. Hip fractures include femoral neck, intertrochanteric or subtrochanteric fractures, and the classification is based on their location. Aug 17, 2017 intertrochanteric fracture of the femur.
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. Fractures are broadly divided into intra and extracapsular fractures and in more detail with the garden classification. The full text of this article is available in pdf format. Relevant anatomy, classification, and biomechanics. The involved patients were collected from the clinics database based on a computer query of current procedural terminology cpt codes for trochanteric fractures. There is limited information on current cost estimates associated with intertrochanteric hip fractures in the united states.
Next, the evansii type intertrochanteric hip fracture model was exported in stl format file. Oct 25, 2019 neck of femur fractures are considered intracapsular fractures also called proximal femoral fractures. Mar 03, 2010 intertrochanteric it femur fractures comprise approximately. Femoral intertrochanteric fractures are com mon among elderly people, accounting for about 50% of hip fractures. Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. A previously undescribed type of fracture of the neck of femur occurred following intertrochanteric fracture fixation with a mclaughlin nail plate in an 80yearold woman.
Barton tm, gleeson r, topliss c, greenwood r, harries wj, chesser tj. The femur and the fixation devices were constructed by using a mimics 14. Evidence from two or more moderate strength studies with consistent findings, or evidence. The management of intertrochanteric hip fractures orthopaedics. Stable, unstable, and subtrochanteric intertrochanteric fractures vary. Intertrochanteric it fractures are one of the most common types of fracture, with a growing incidence subsequent to increasing longevity of the population. Unstable intertrochanteric fracture, pfn proximal femoral nail, functional outcome. An intertrochanteric fracture is a specific type of hip fracture. Poor prognosis after surgery for intertrochanteric. Intertrochanteric femur fracture statpearls ncbi bookshelf. Trochanteric fracture, proximal femoral extracapsular fracture, hip arthroplasty, trochanteric. However, most systems lack reliability and, in general, intertrochanteric fractures can be divided into two categories.
Treatment of intertrochanteric fractures of the femur pdf. Orif for hip fractures inr should be reversed to hip fracture surgery. Two percent routinely fixed unstable intertrochanteric fractures with. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Biomechanical study of reduction quality and effects of the medial. Femur fracture reaming reaming of the femoral shaft fracture only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in acute femur fracture patients with pulmonary trauma in both a retrospective analysis and multiple animal studies pape, j trauma 1992. Listen to the audio pronunciation in the cambridge english dictionary. What makes an intertrochanteric fracture unstable in 2015. These fractures are called intertronchanteric hip fractures. Fractured intertrochanteric undisplaced subcapital fracture. 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. Technical difficulties and results in trochanteric fractures 235. The distal capsular attachment on the femur follows the shape of the irregular rim between the head and the neck. 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.
The treatment of intertrochanteric femoral fractures a randomised. Stable intertrochanteric fractures moderate evidence supports the use of either a sliding hip screw or a cephalomedullary device in patients with stable intertrochanteric fractures. Two types of intertrochanteric hip fracture fixation models pfna fixation and im. Intertrochanteric femur fractures orthopaedicsone articles.
There is a greater trochanter on the outside and a lesser trochanter on the opposite side. When using a trochanteric entry nail, start slightly medial to. Scott ih 1957 treatment of intertrochanteric fractures by skeletal pinning and external. Like the intertrochanteric fracture, these injuries often occur with significant comminution. The importance of the cortical buttress of bone on the. 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. External fixation in unstable intertrochanteric fractures of. Fracture patterns which is included in this study, with code for each fracture according to the ao classification a311. Concomitant ipsilateral subcapital and intertrochanteric. Operative treatment is complicated further by the need for extensive surgical exposure. Nail or plate fixation of intertrochanteric hip fractures. To compare two internal fixation devices clinically in stabilisation of intertrochanteric femur fractures. Treatment of intertrochanteric hip fractures in elderly. This case demonstrates an intertrochanteric fracture with displacement.
Also with limited access approach, one can reduce the blood loss, soft tissue trauma and infection. Panchanadikar v 2016 proximal femur nail in intertrochanteric fractures indications and tipstricks. Trochanteric buttress plate combined with proximal femoral. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. 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. Many systems of classification, such as the evans system, have been used to describe intertrochanteric hip fractures. Fracture classification the proximal femoral fractures are classified as 31 fractures.
Another metaanalysis recommend the intramedullary nail technique for the treatment of unstable femoral intertrochanteric fractures due to better functional outcomes and. Risks of a fractured intertrochanteric undisplaced subcapital fracture there are risks and complications with this procedure. Patients with femoral neck and intertrochanteric fractures. Femur intertrochanteric fracture an overview sciencedirect topics. 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. We have thus presented the various bone and soft tissue injuries other than proximal femur fractures in patients with negative plain radiographs. We advocate fixation of 31a1 fractures with a sliding hip screw and all others with an intramedullary device. Video lecture with narrations and live annotations from. Screws are placed in the proximal and distal femur to stabilize the fracture site.
Download full thesis topics for ms dnb orthopaedics degree orthodnb. Trochanteric fractures are classified, with special emphasis on the stability or instability of the fracture. 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. In conclusion, prognosis after surgery for intertrochanteric fracture was poorer in elderly patients with clopidogrel treatment.
Pdf the treatment of intertrochanteric fractures of the. Of 119 intertrochanteric fractures treated from june 2007 to december 2008, twentyone hips showed sagittal instability. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary. Fixation of intertrochanteric femur fractures using proximal femoral nail antirotation pfna in the lateral decubitus position without a traction table presented as oral presentation at the european hip society 11th congress october, 911, 2014, stockholm, sweden. The literature on hemiarthroplasties for unstable intertrochanteric fractures is sparse. Internal fixation of intertrochanteric hip fractures. Extracapsular fractures of the proximal femur between the greater and lesser trochanters. Classifications of intertrochanteric fractures and their. 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. Incidence and economic burden of intertrochanteric fracture. Failed subtrochanteric fracture how i decide what to do.
These hip fractures are usually the result of a fall and often are the hardest type of fracture to treat. Pccp can reduce complications and improve fracture healing and rehabilitation in patients with in tertrochanteric hip fractures 9. The purpose of the present study was to estimate the incidence and economic burden of both intertrochanteric and all hip fracture types in the medicare patient population to the u. We advocate fixation of 31a1 fractures with a sliding hip screw and all. Download full thesis topics for ms dnb orthopaedics degree. Help with complete thesis work available for download in all subjects.
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. Hammering in a long intramedullary nail that is impinging on the anterior cortex can produce an iatrogenic fracture. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Fractures of the femur distal to the lesser trochanter are less common than the femoral neck and intertrochanteric fractures. A comparison of the long gamma nail with the sliding hip. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw. Fracture union was achieved by an average time of 14 weeks in all the patients. Jan 04, 2016 lecture 4 of 4 on proximal femur fractures adapted from ota lecture series. 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. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. Intertrochanteric fractures of the femur slideshare.
An intertrochanteric fracture is a common hip fracture that happens most often in older adults. 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. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur. Apr 05, 2015 intertrochanteric fracture classification by kyle 7. Download thesis pdf files, complete thesis dissertation work. Jul 25, 2015 according to aoota alphanumeric classification intertrochanteric fractures type 31a bone femur 3,segment proximal 1,type a1, a2, a3 a1.
Operation methods, advantages and disadvantages and prognosis in intertrochanteric femur fractures. Role of proximal femoral nail in the treatment of unstable intertrochanteric fractures asad khan ghilzai1, syed kamran ali shah2, muhammad ayub khan3, muhammad arsalan ghazi2 and muhammad kazim rahim najjad1 1consultant orthopaedics,trauma orthopaedic clinic, pakistan 2resident orthopaedics, liaquat national hospital, pakistan. 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. Femoral neck fracture following intertrochanteric fracture. Intertrochanteric fracture classification by kyle 7. Role of proximal femoral nail in the treatment of unstable. 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. Salvage of failed internal fixation of intertrochanteric hip. All patients received 3rd generation cephalosporins as antibiotics, low molecular weight heparin lmwh, mor. Forty elderly patients aged 5094 years old with unstable intertrochanteric fractures were treated by external fixation at the central institute of orthopaedics, safdarjang hospital, new delhi, india from june 1993 to january 1995. 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. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer.