6. IntertrochantericFracture
•An intertrochanteric hip fracture occurs between
the greater trochanter, where the gluteus medius
and minimus muscles (abductors) attach, and the
lesser trochanter, where the iliopsoas muscle (hip
flexor) attaches
•Common in elderly osteoporotic patient
•Usually in woman
•Unite easily and rarely cause avascular necrosis
7. •Anatomy
•Intertrochanteric line: anterior ridge between
greater and lesser trochanters
•Extracapsular, transition between femoral
neck
and shaft
•Mechanism
•Resulting from fall
8.
9. Mechanism
• In younger individuals are usually the result of a high-energy
injury, such as a motor vehicle accident (MVA) or fall from a
height
• In the elderly, it results from a simple fall.
10. Evans Classification
• Useful for
deciding
stability and
treatment of
intertrochanter
ic fractures.
Also, reverse
obliquity
fractures are
unstable and
treated like
subtrochanteric
fractures
11. Signs &Symptoms
• Pain
• Marked shortening of lower limb
• Patient cannot lift his/her leg
• Complete External Rotation Deformity
• Swelling, ecchymoses and Tenderness over the Greater Trochanter
• Displaced fractures are clearly symptomatic, such patients usually
cannot stand, much less ambulate
• Nondisplaced fractures may be ambulatory and experience
minimal pain
• The amount of clinical deformity in patients with an
intertrochanteric fracture reflects the degree of fracture
displacement
14. Management
• Management depends on completeness and
stability
• Risk of AVN and nonunion less than in femoral neck
fractures
• basicervical fractures treated like intertrochanteric
fractures
15. cont
• Complete:
• Stable: Dynamic plate and screw
• Unstable or reverse obliquity: Intramedullary device
• Incomplete
• Obtain MRI to ensure fracture not complete
•If incomplete and <50% fracture width, potentially can
treat conservatively
• Risk of fracture completion
