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Subtrochanteric Fracture Updated 12/2006

Carl Wierks, MD, Emmanuel Hostin, MD
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BASICS

  • Description
  • General Prevention
  • Epidemiology
  • Risk Factors
  • Etiology
  • Associated Conditions

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Pathophysiology
  • Differential Diagnosis

TREATMENT

  • General Measures
  • Special Therapy
  • Medication (Drugs)
  • Surgery

Ongoing Care

  • Prognosis
  • Complications
The following is an excerpt....
BASICS
Description
  • By definition, subtrochanteric hip fractures (or, simply, subtrochanteric fractures) extend into the region between the lesser trochanter and a point 5 cm distally.
  • Classification:
    • Multiple systems exist, but prognostically the most critical factor is fracture stability, which is based on the degrees of comminution of the medial and posteromedial cortex.
    • The Russell and Taylor classification (1):
      • Useful for guiding treatment because it differentiates fractures that extend into the piriformis fossa from those that do not.
      • This distinction is important because a cephalomedullary nail enters the femur at the piriformis fossa and therefore should not be used if the fossa is fractured (2).
  • The medial and posteromedial cortices sustain the great compressive forces.
    • Comminution in this area renders the ...

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FIGURE 5-22. A,B: Anteroposterior (AP) and lateral x-rays showing an undisplaced intertrochanteric fracture in a 30-year-old laborer who fell 12 feet onto his hip while at work. He was treated symptomatically with bed rest for 2 days and then was up on crutches and out of the hospital. C,D: AP and lateral x-rays show healing evident at 4 weeks when the patient was able to return to work on a full-time basis. It's questionable whether this would have been likely if he had been treated with open reduction and internal fixation of this completely undisplaced fracture.Credit: From Bucholz RW, MD and Heckman JD, MD. Rockwood & Green's Fractures in Adults, 5th ed. Lippincott, Williams & Wilkins, 2001
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