An intertrochanteric hip fracture occurs lower than a femoral neck fracture.

Intertrochanteric hip fractures have a

different treatment because they do not have the issues with damage to blood flow to bone seen with the femoral
neck fractures. Because the bone blood flow is usually in tact, these fractures can usually be repaired, and do not
require the hip replacement procedure described previously.

What is the treatment of an intertrochanteric hip fracture?

Intertrochanteric fractures are usually repaired with a metal plate and screws. The patient is given a general or
spinal anesthesia in the operating room. They are then positioned in a manner to realign the fractured bone. Once
the fracture is well positioned and confirmed to be in a good position using x-ray, an incision is made on the
outside of the thigh. The femur (thigh bone) is exposed, and a metal plate is placed along the outside of the thigh
bone using several small screws. A large screw is inserted across the fracture and into the femoral head. This large
screw is held to the plate. Together, this plate and screw implant holds the broken bones in place.

Throughout the procedure, your surgeon will use x-ray to confirm the position of the implants and ensure the
fracture is well aligned. The incision is about 8 centimeters long.

Some surgeons are using a newer implant that uses some of the same principles described here, but uses a rod
inserted down the center of the bone rather than a plate along the outside of the bone. Both types of fracture
fixation (the plate and the rod) have shown good healing and have had excellent results.

What is the rehabilitation following treatment for an intertrochanteric hip fracture?

Patients are usually allowed to begin walking immediately following surgery. In some cases, if there were small
fracture fragments or difficulty with alignment of the fracture, weight may be restricted. Most commonly, patients
will get up with the physical therapist within a day following surgery. Time for complete healing is usually about 12
weeks, but most patients are walking well before that time.

How is a fracture diagnosed?

When you arrive for medical care, the doctor will take a history of the injury. Where, when, and why did the injury
occur? Did the person trip and fall, or did they pass out before the fall? Are there other injuries that take precedence
over the fracture? For example, a person who falls and hurts their wrist because they had a stroke or heart attack will
have their fracture care delayed to allow care for the life threatening illness. The injured area will be examined and a
search will happen for potential associated injuries. These include damage to skin, arteries and nerves.

Pain control is a priority and many times, pain medication will be prescribed before the diagnosis is made. If the
doctor believes that an operation is likely, pain medication will be given through an intravenous (IV) line or by an
injection into the muscle. This allows the stomach to remain empty for potential anesthesia.

A decision will be made whether x-rays are required, and which type of x-ray should be taken to make the diagnosis
and better assess the injury. There are guidelines in place to help doctors decide if an x-ray is necessary. Some
include the Ottawa ankle and knee x-ray rules.

The body is three dimensional, and plain film x-rays are only two dimensional. Therefore, two or three x-rays of the
injured areas may be taken in different positions and planes to give a true picture of the injury. Sometimes the
fracture will not be seen in one position, but is easily seen in another.
 There are areas of the body where one bone fracture is associated with another fracture at a more distant part. For
example, the bones of the forearm make a circle and it is difficult to break just one bone in that circle. Think of trying
to break a pretzel in just one place, it is difficult to do. Therefore broken bones at the wrist may be associated with an
elbow injury. Similarly, an ankle injury can be accompanied by a knee fracture. The doctor may x-ray areas of the
body that don't initially appear to be injured.

Occasionally, the broken bone isn't easily seen, but there may be other signs that a fracture exists. In elbow injuries,
fluid seen in the joint on x-ray is an indicator of a subtle fracture. And in wrist injuries, fractures of the scaphoid or
navicular bone may not show up on x-ray for one to two weeks, and diagnosis is made solely on physical examination
with swelling and tenderness over the snuffbox at the base of the thumb.

In children, bones may have numerous growth plates that can cause confusion when reading an x-ray. Sometimes,
the doctor will choose to x-ray the opposite arm or leg to determine what normal is for the child before deciding
whether a fracture exists.

What is the treatment of a fracture?

Initial treatment for fractures of the arms, legs, hands and feet in the field include splinting the extremity in the position
it is found, elevation and ice. Immobilization will be very helpful with initial pain control. For injuries of the neck and
back, many times, first responders or paramedics may choose to place the injured person on a long board and in a
neck collar to protect the spinal cord from potential injury.

Once the fracture has been diagnosed, the initial treatment for most limb fractures is a splint. Padded pieces of
plaster or fiberglass are placed over the injured limb and wrapped with gauze and an elastic wrap to immobilize the
break. The joints above and below the injury are immobilized to prevent movement at the fracture site. This initial
splint does not go completely around the limb. After a few days, the splint is removed and replaced by a
circumferential cast. Circumferential casting does not occur initially because fractures swell (edema). This swelling
would cause a build up of pressure under the cast, yielding increased pain and the potential for damage to the tissues
under the cast.

Surgery

Surgery on fractures are very much dependent on what bone is broken, where it is broken, and whether the
orthopedic surgeon believes that the break is at risk (for staying where it is) once the bone fragments have been
aligned. If the surgeon is concerned that the bones will heal improperly, an operation will be needed. Sometimes
bones that appear to be aligned normally are splinted, and at a recheck appointment, are found to be unstable and
require surgery.

Surgery can include closed reduction and casting, where under anesthesia, the bones are manipulated so that
alignment is restored and a cast is placed to hold the bones in that alignment. Sometimes, the bones are broken in
such a way that they need to have metal hardware inserted to hold them in place. Open reduction means that, in the
operating room, the skin is cut open and pins, plates, or rods are inserted into the bone to hold it in place until healing
occurs. Depending on the fracture, some of these pieces of metal are permanent (never removed), and some are
temporary until the healing of the bone is complete and surgically removed at a later time.