An intertrochanteric fracture occurs in the area between the greater and lesser trochanters of the femur. It is usually caused by a minor fall in elderly patients and major trauma in adults. Diagnosis is made through clinical examination finding pain and inability to move the leg as well as x-ray showing comminution of the medial femoral cortex. Treatment options include conservative methods like traction or operative fixation using devices like dynamic hip screws or gamma nails to maintain the normal femoral neck shaft angle and allow healing. Complications can include malunion leading to limping or shortening and osteoarthritis from changes in hip biomechanics.

1. By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Inter-trochanteric fracture

2. • May involve either greater trochanter or lesser
trochanter or both
• Elderly by minor force
• Adult by major force
• Femoral neck shaft
angle is reduced (Coxa vara)
• Comminuted and displaced fracture
• Very rarely undisplaced fracture

3. Diagnosis
• Clinical features
• History of fall or accident
• Pain, swelling, tenderness
• Inability to move leg
• Physical findings are more marked compared to
neck of femur fracture

4. • Easy to diagnose on X-ray
• Comminution of the medial
cortex of the neck of femur
• Avulsion of lesser
trochanter
• Extension of the fracture of
the sub trochanteric region
indicates unstable fracture
and poor prognosis

5. Treatment
• It unites readily
• Main objective is to maintain a normal
femoral neck shaft angle
• In elderly patient, ORIF is preferred to prevent
complications

6. • Conservative method
– Russell’s traction and
– Thomas splint

7. • Operative method
– Internal fixation used are
• Dynamic Hip Screw
• Ender’s nail
• Gamma nail
– External fixation is used for patients with bed
sores

10. Complications
• Malunion
– Coxa vara
– Elderly mild limping while walking and shortening
– Suitable shoe raise
– Adult
– Corrective osteotomy

11. • Osteoarthritis
– Due to change in hip biomechanics
– Pain and stiffness
– Physiotherapy treatment
– Later trochanteric osteotomy or THR

12. Thank you

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