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The proximal femur consists of the femoral head, femoral neck, and the trochanteric region. An intertrochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and minimus muscles (hip extensors and abductors) attach, and the lesser trochanter, where the iliopsoas muscle (hip flexor) attaches.
decreased muscle tone of the muscles in the area secondary to the aging process. The increasing bone fragility results from osteoporosis and osteomalacia secondary to a lack of adequate ambulation or antigravity activities, as well as decreased hormone levels, increased levels of demineralizing hormones, decreased intake of calcium and/or vitamin D, and other aging processes.
The current treatment of intertrochanteric fractures is surgical intervention. Despite an acceptable healing rate with nonsurgical methods, surgical intervention for intertrochanteric fractures has replaced previous nonsurgical methods of
Though healing rates for previous nonsurgical methods may have been acceptable, they were accompanied by unacceptable morbidity and mortality rates because of frequent nonorthopedic complications associated with prolonged immobilization or inactivity. Complications included the following:
Loss of motion of the lower extremity joints and muscle atrophy due to prolonged immobilization.
Union of the fracture in an unacceptable position resulting in a deformity. (Known as a malunion, the fracture heals with unacceptable shortening, rotation, and/or angulation of the extremity, resulting in decreased mobility and subsequent handicap, impairment, and disability.)
The subtrochanteric region of the femur, arbitrarily designated as the region between the lesser trochanter and a point 5 cm distal, consists predominantly of cortical bone. Healing in this region is predominantly through a primary cortical healing. Thus, the fracture is quite slow to consolidate. During normal activities of daily living, up to 6 times the body weight is transmitted across the subtrochanteric region of the femur.
In high-energy fractures, a complete system examination must be performed. Associated injuries to the cranium, thorax, and abdomen must be recognized. Pelvic, spine, and long bone injuries are also common, especially on the ipsilateral side, and these should be identified early to optimize treatment and outcomes.