The document discusses trochanteric hip fractures, which occur in the area between the greater and lesser trochanters. These fractures are extracapsular and more common in elderly females. Clinical features include pain in the hip, leg shortening, external rotation deformity, swelling, and tenderness over the greater trochanter. Treatment options include conservative management for high-risk patients or surgical fixation to stabilize the fracture. Surgical techniques include closed or open reduction with implants like dynamic hip screws or proximal femoral nails.

1. Trochanteric fracture
Gopisankar.M.G.
2008 MBBS

2.  Occurs along a line between greater trochanter and
lesser trochanter with variable comminution
 Totally extracapsular
 Four times more common than intracapsular

3.  Age  seen in elderly patients 10 – 12 years older than
intracapsular # neck of femur
 Sex  f:m = 2.8 : 1

4. Clinical features
 Pain in the hip
 Marked shortening of the lower limb
 Complete external rotation deformity
 Swelling
 Echymosis
 Tenderness over the greater trochanter

5. X ray

7. Treatment
 Conservative  10% mortality
 Surgical

8. Conservative
 Indication
1. Poor medical and surgical risk patients
2. Terminally ill patients
3. Very old patients
 Methods
1. Simple support with pillows
2. Buck’s traction
3. Plaster spica
4. Skeletal traction through distal femur or tibia for 10 – 12
weeks

9. Buck’s traction

10. Hip spica

11. Traction using Bohler Braun
frame

12. Surgical
 10 fold rise in mortality if surgery is delayed for > 48
hrs.
 Goal is to fix a stably reduced fracture internally

13. Methods of reduction
 Closed Reduction  traction , slight abduction and
external rotation if cannot reduce  open reduction
done
 Open Reduction  indications
1. Failed closed reduction
2. Large spike on proximal fragment with lesser trochanter
intact
3. Reverse oblique fracture
 Reduction Anatomically /non anatomically

14. Implants
 Dynamic Hip screw (DHS)
 Proximal Femoral nails (PFN)

15. Dynamic Hip Screws

16. Proximal Femoral Nails

17. Complications
 Malunion
 Coxa vara
 Traumatic Osteoarthritis