Intertrochanteric femur fracture

Background

• Occur via fall in elderly or osteoporotic

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Clinical Features

• Typically pain, swelling, ecchymosis
  • May lose 1-2L of blood
• Unable to bear weight
• Shortening and external rotation if fracture is significantly displaced

Differential Diagnosis

Hip pain

Acute Trauma

• Femur fracture
  • Proximal
    • Intracapsular
      • Femoral head fracture
      • Femoral neck fracture
    • Extracapsular
      • Intertrochanteric femur fracture
      • Trochanteric femur fracture
  • Shaft
    • Mid-shaft femur fracture (all subtrochanteric)
• Hip dislocation
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture

Chronic/Atraumatic

• Hip bursitis
• Psoas abscess
• Piriformis syndrome
• Meralgia paresthetica
• Septic arthritis
  • Septic arthritis of the hip (peds)
• Obturator nerve entrapment
• Avascular necrosis of hip

Evaluation

Workup

Hip fracture classification.

Location of femur fractures

• Consider AP pelvis in addition to AP/lateral views to compare contralateral side
• Consider MRI if strong clinical suspicion but negative x-ray

Diagnosis

Garden's classification of intertrochanteric fractures

Intertrochanteric femur fracture.

• Stable (Garden's type I and II)
  • Lesser trochanter non-displaced, no comminution, medial cortices of prox/distal fragments aligned
• Unstable (Garden's type III and IV)
  • Displacement occurs, comminution is present, or multiple fracture lines exist

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Ortho consult

Disposition

• Admit

Specialty Care

• Typically requires ORIF