The full text of this article is available in pdf format. Sep 15, 2014 due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly patients is challenging and controversial 3, 4. Additionally, sliding of the hip screw and proximal femur shortening are expected to occur more frequently after dhs. Incidence and economic burden of intertrochanteric fracture. Care must be taken to rule out the more benign isolated fracture of the greater trochanter.
Nine failures of 308 femoral intertrochanteric fracture patients with. Jul 25, 2015 major complications following the intertrochanteric fracture fixation surgery are. It works by targeting the many facets of health, and its proving to be a viable treatment option and pain reliever for geriatric patients. Intertrochanteric fracture treatment fracture reduction at surgery is performed on a fracture table that provides slight traction and internal rotation. Osteoporosis and instability are the most important factors preventing early weight bearing and leading to unsatisfactory results in these cases 3, 5, 6. Currently, only 1 in 4 patients after a hip fracture receives treatment and work up for osteoporosis, the underlying cause of most of the fractures. The management of intertrochanteric hip fractures sciencedirect. Intertrochanteric femur fractures orthopaedicsone articles. This is perhaps the most important measurement of accurate hardware placement and has been shown in multiple studies to be predictive of success after the treatment of standard obliquity intertrochanteric fractures. Complication risk after treatment of intertrochanteric hip. Fractures of the intertrochanteric region are most commonly occurring fractures of. Classifications of intertrochanteric fractures and their. Treatment of recent trochanteric fracture in adults emconsulte. The most common treatment for intertrochanteric fractures is surgery.
The cancellous bone in this intertrochanteric region is well vascularized. Aug 17, 2017 intertrochanteric fracture of the femur. Open reduction internal fixation orif with intra or extramedullary implants is the most frequent attitude in these fractures, which usually heal easily. This is referred to as a hemiarthroplastymonopolar arthroplasty. In addition fracture healing was generally accompanied by varus deformity and. This allows you to put weight on it right after surgery. How to treat the complex unstable intertrochanteric. An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to. Compared to dhs treatment, pfna treatment of type a1 intertrochanteric fractures is associated with reduced blood loss, shorter operation time, and less severe pain after surgery. This type of fracture is primarily repaired using an intramedullary nail.
This evans classification breaks down intertrochanteric femur fractures based on displacement, number of fragments. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. Intertrochanteric fracture definition of intertrochanteric. Most hip fractures would actually heal without surgery, but the problem is that you would be in. A new device for the treatment of intertrochanteric fractures that uses 2 cephalocervical screws in an integrated mechanism allowing linear intraoperative compression and rotational stability of the headneck fragment has been developed. Concomitant ipsilateral subcapital and intertrochanteric. You and your fractured hip hip precautions 2 treatment will depend on the location, type and severity of the fracture. Intertrochanteric fractures archives trauma international. The lesser trochanter is an attachment point for one of the major muscles of the hip. Trochanteric fractures, internal fixation, arthroplasty, surgical technique. The aim of this study was to describe the results using this device for the treatment of stable and unstable intertrochanteric fractures.
A 36yearold caucasian man was admitted with this rare fracture. In most cases, surgery is recommended because this fracture can take a long time to heal on its own. This case demonstrates an intertrochanteric fracture with displacement. Lower limb clinical and functional outcomes of treatment. Lower limb clinical and functional outcomes of treatment for. Femoral intertrochanteric fracture, sliding hip screw, targon. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Aug 02, 2017 the most common treatment for intertrochanteric fractures is surgery. Reason and treatment of failure of proximal femoral nail. Trochanteric fractures of the femur occur in older patients than do femoral neck fractures.
Biomechanical study of reduction quality and effects of the medial. An isolated fracture of the greater trochanter may occur as an avulsion by the gluteus medius, and needs only symptomatic palliative treatment. If there is additional comminution extending into the medial buttress calcar, the fracture is unstable. Complication risk after treatment of intertrochanteric hip fractures in the medicare population. The typical it fracture has a primary fracture line oriented from the greater trochanter proximal and lateral to the lesser trochanter distal and medial. Femur, intertrochanteric fractures, compression hip nail. Comparisons of internal fixation treatments for femoral. Unstable intertrochanteric hip fractures account for approximately one quarter of all hip fractures in the elderly and are increasing in frequency. Treatment goals include immediate mobilization while limiting complications. The intramedullary nail is placed in the marrow canal of the fractured extremity to correct the fracture and strengthen the bone.
The treatment of intertrochanteric fractures of the femur surgery. Reason and treatment of failure of proximal femoral nail antirotation internal fixation for femoral intertrochanteric fractures of senile patients j. Treatment of intertrochanteric fractures using the. How to treat the complex unstable intertrochanteric fractures. Sliding hip screw is superior for treatment of reverse obliquity intertrochanteric fractures. Treatment of periimplant fractures of the femur steven i. Intramedullary hips nails are currently considered the implants of choice for the surgical treatment of patients with trochanteric fractures. Fractures are broadly divided into intra and extracapsular fractures and in more detail with the garden classification this determines the surgical treatment. Implant cutout this still remains the commonest cause of failure of the implantfracture construct. Because they are located distal to the anatomic limits of the hip joint capsule, fractures in the region between the greater and lesser trochanters are characterized as extracapsular fractures figure 6. Intertrochanteric fracture this fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. Pdf the treatment of intertrochanteric fractures of the. Current treatment options nonoperative treatment before the introduction of suitable fixation devices in the 1960s, treatment for intertrochanteric fractures was of necessity nonoperative, consisting of prolonged bedrest in traction until fracture healing occurred usually 10 to 12 weeks, followed by a lengthy program of ambulation. The cause of postoperative failure after the treatment of femoral intertrochanteric fracture with proximal femoral nail antirotation pfna was analyzed, and the reoperative methods were examined.
Fractures of the intertrochanteric region are most commonly occurring. Prosthesis removal, strut medial allograft, and long stem femoral revision followup allograft incorporated and. There is a greater trochanter on the outside and a. Jul 25, 2015 many attempts to classify these fractures are made and different scientific rationale are applied by various authors. An intertrochanteric hip fracture occurs three to four inches from the hip joint. We aimed to evaluate and compare the clinical and functional outcomes of dynamic hip screw dhs and. Here we tried to provide an overview of both old and new classification of intertrochanteric fractures and also provide with the clinical significance of the same keywords. Unstable intertrochanteric fracture of femur, cemented bipolar hemiarthroplasty for treatment of unstable intertrochanteric fracture introduction intertrochanteric fracture in the elderly patient is a frequent problem and is becoming more common as the proportion of elderly people in the population increases fig 1 1. 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. Treatment of intertrochanteric hip fractures in elderly. Comparison of dynamic hip screw and proximal femoral nail antirotation. Acupuncture can help heart disease, diabetes, high blood pressure, and alzheimers disease. Sep 10, 2015 complication risk after treatment of intertrochanteric hip fractures in the medicare population.
Femoral neck mortality for node 3 internal fixation screws vs. 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. Intertrochanteric between the greater and lesser trochanter. The aim of this retrospective study was to evaluate the results of the external fixation for the treatment of intertrochanteric hip fractures in a group of high surgical risk elderly patients. Cai 1department of orthopedic surgery, shanghai tenth peoples hospital, tongji university, school of medicine, shanghai, china. Iithe third military medical university, key laboratory of biomechanics and tissue engineering under the. Treatment of recent trochanteric fracture in adults.
Mar 20, 2018 getting older can stink and none of us are unsusceptible. Intertrochanteric fractures generally cross in the area between the lesser trochanter and the greater trochanter. Apr 05, 2015 intertrochanteric fracture treatment fracture reduction at surgery is performed on a fracture table that provides slight traction and internal rotation. Preoperatively, medical comorbidities should be identi. Hip fracture guide treatment options the treatment for a hip fracture begins immediately by making sure you are medically stable. A doubleblind, prospective, randomised, controlled clinical.
There is limited information on current cost estimates associated with intertrochanteric hip fractures in the united states. 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 femur fracture statpearls ncbi bookshelf. Articles were also contributed from personal files of the authors and tep members. Orif for hip fractures inr should be reversed to fracture surgery. Short versus long cephalomedullary nailing for the treatment of intertrochanteric hip fractures in patients over 65 years old. Early operation on patients with a hip fracture improved the ability to return to independent living. The aim of this study was to describe the results using this device for the treatment of stable. 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 fracture healed fell 1 year later sustaining femoral neck fracture at tip of lag screw xrays showed poor bone stock. This evans classification breaks down intertrochanteric femur fractures based on displacement, number of fragments and. 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. However, results from patients in the 20 mm sliding lag screw group were better than for the 10 mm sliding lag screw group. You and your surgeon will decide how to repair the hip by replacing the femur ball.
Fracture treatment maximize weight bearing avoid bed rest 1% bone mass loss per week treat as a pathologic fracture medical management in almost all. Nail or plate fixation of intertrochanteric hip fractures. Data on patients 65 years or older who underwent treatment of an intertrochanteric hip fracture with intramedullary nail were collected from a prospectively gathered. Treatment early precollapse stages core decompression operation. Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Implant cutout this still remains the commonest cause of failure of the implant fracture construct. Review article comparisons of internal fixation treatments. The bump on the outside of the femur just below the femoral neck is called the greater trochanter.
Intertrochanteric frac ture accounts for 50% of hip fractures 6, and in most patients, intertrochanteric fracture is accompanied by internal diseases. Original article clinical and biomechanical studies on. Oct 01, 20 intertrochanteric fractures hip fracture 1. More than half of adults age 65 or older have 3 or more medical problems, such as heart disease, diabetes, arthritis, alzheimers disease, or high blood pressure. Current treatment standards include the starting of a bisphosphonate to reduce future fracture risk. As a medical provider, it can be a real challenge to treat an older patient. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. 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. A doubleblind, prospective, randomised, controlled. Rabin dreyer medical clinic created january 2006 revised august 2009. Therefore, use of the 20 mm sliding lag screw is advisable. Major complications following the intertrochanteric fracture fixation surgery are. Managing perioperative risk in the hip fracture patient. 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.
Cemented modular bipolar hemiarthroplasty of hip in treatment. This fracture occurs between the neck of the femur and a lower bony prominence called the lesser trochanter. For the typical orientation, a primary fracture line connotes stability. Older theories about screw placement favored a low and occasionally a posterior position of the lag screw.
There is a greater trochanter on the outside and a lesser trochanter on the opposite side. Mar 03, 2010 the typical it fracture has a primary fracture line oriented from the greater trochanter proximal and lateral to the lesser trochanter distal and medial. Cemented modular bipolar hemiarthroplasty of hip in. Hip fracture as risk factor papaioannou 2001, j bone min res 15supp. It is an accepted almost dogmatic mandate that the tip apex distance correlates directly with implant cutout, with higher the tad, the greater is the risk of. Obtaining rigid fixation is difficult because of severe osteoporosis, posterior medial cortical collapse, and calcar femorale defects. The incidence of intertrochanteric fractures is gender and racedependent and varies from country to country.
Short versus long cephalomedullary nailing for the. Hip fractures in the elderly represent a major challenge the healthcare systems around the globe have to face. Once the doctor is sure that you are stable, decisions concerning the treatment of the fracture can be made. Due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly patients is challenging and controversial 3, 4. Femoral intertrochanteric fracture, sliding hip screw, targon proximal femoral, network metaanalysis introduction. Resources on intertrochanteric fractures evans classification and related topics in orthopaedicsone spaces. Internal fixation is the treatment of choice for treating i ntertrochanteric. Hip fracture patients are typically older than age 65, with a mean age of 85. No optimal internal fixation treatment was identified for femoral intertrochanteric fracture, but pfn may be a better treatment option for unstable femoral intertrochanteric fractures. Clinical and functional outcomes of treatment for type a1 intertrochanteric femoral fracture in elderly patients. The use of chn for the treatment of intertrochanteric fracture yielded poor results.