2. CASE
Male 41 Yrs. U/D DM
CC : ลื่นล้ม 1 day PTA
PI : 1 day PTA ขณะอยู่ในห้องน้ำ ลื่นล้มสะโพกกระแทกพื้น ปวด
บริเวณสะโพกซ้ำย ลุกเองไม่ขึ้น เดินไม่ได้ ไม่มีศีรษะกระแทกพื้น ไม่
บำดเจ็บบริเวณอื่น
3. Primary Survey
A. Can talk, No neck pain, can move neck, not
tender along c-spine
B. No wound, no dyspnea, clear breath sound,
no adventitious sound, trachea in midline
C. BP 148/72 mmHg, HR 82/min, no external
wound
D. E4V5M6, pupil 3mm RTLBE
E. Tender left hip, limit ROM due to pain
15. INTERTROCHANTERIC FRACTURES
Mechanism of injury
Elderly - Occur as the result of a fall
Younger - May occur with major trauma
(high incidence of associated internal and
orthopedic injury)
16. Symptoms and examination findings
Hip pain
Swelling
Ecchymosis
Injured leg may be shortened (and externally rotated )
19. Nonoperative management
• Nonambulatory or demented patients with mild
pain
• Unstable patients with major, uncorrectable
comorbid disease
• Patients at the end stage of a terminal illness
Methods
• Very old patients - Buck’s traction
• Plaster/Hip spica
• Skeletal traction through distal femur or tibia for 10
– 12 weeks with Bohler-Braun Splint
