INTERTROCHANTER

FEMUR FRACTURE
M.AKHYAR BAHARUDDIN
20194010011
Definition :
An intertrochanteric hip fracture occurs between the
greater trochanter, where the gluteus medius and mi
nimus muscles (hip extensors and abductors) attac
h, and the lesser trochanter,where the iliopsoas mus
cle (hip flexor) attaches
 Etiology
 Intertrochanteric fractures occur as consequences of either high-en
ergy trauma (rare; seen in young male patients) or simple low-energ
y falls (common; seen in elderly female patients).

 The etiology of low-energy intertrochanteric fracture is a combinatio

n of the following factors:
1. Increased bone fragility of the intertrochanteric area of the femur (o
steoporosis, osteomalacia , decreased intake of calcium/vitamin D)
2. Decreased agility and decreased muscle tone of the muscles in the
area secondary to aging
Epidemiology
• insidensi :
- Among individuals older than 60 years
- The mean age for this fracture is 81 years
- female:male 2:1
In this group, the major contributing factors are osteoporosis and the propensity of old
er patients to fall.

In the age group between 11 and 60 years, however, males sustain more fractures tha
n females
The causative factor in this age group is high-energy trauma.
Risk factor

1.Osteoporosis
2. Fall down
3. Muscle Weakness
Mechanism of injury
 Intertrochanteric fractures in younger individuals are
usually the result of a high-energy injury, such as a
motor vehicle accident (MVA) or fall from a height

 In the elderly, it results from a simple fall (trivial

trauma). The tendency to fall increases with patient
age and is exacerbated by several factors including
- poor vision
- decreased muscle power
- decreased reflexes
Classification
Orthopaedic Trauma Association ( OTA )
Boyd & griffin’s classification
1. Linear IT line #
2. Linear IT line # with comminution
3. Subtrochanteric #
4. Inter-/Subtrochanteric # with extension into
proximal femoral shaft
Sign and symptoms
- Pain
- Marked shortening of lower limb
- Patient cannot lift his/her leg
- Complete External Rotation Deformity
- Swelling, ecchymoses and Tenderness over the Greater
Trochanter
Diagnostic
1.(AP) view of the pelvis .
2.AP and a cross-table lateral view of the involved proximal femur
When a hip fracture is suspected but not apparent
on standard x-rays, a technetium bone scan or a
magnetic resonance imaging (MRI) scan should
be obtained. MRI has been shown to be at least as
accurate as bone scanning in identification of
occult fractures of the hip, and it will reveal a
fracture within 24 hours of injury.
Treatment
Non operative

Indication
Poor medical and surgical risk patients
Terminally ill
Methods
Very old patients - Buck’s traction
Plaster/Hip spica
Skeletal traction through distal femur or tibia for
10 – 12 weeks with Bohler-Braun Splint
Operative

Intertrochanteric fractures are almost always treated by early intern

al fixation – not because they fail to unite with conservative treatme
nt (they unite quite readily), but
(a) Obtain the best possible position
(b) Early ambulation to reduce the complications associated with
prolonged recumbency

The patient with an intertrochanteric fracture is ready to proceed wi

th surgery after the medical or trauma evaluation has been complet
ed and the medical conditions have been stabilized without undue
delay.
Compression hip screw (sliding hip screw)
Sliding hip screw devices
The sliding hip screw is the most widely used implant for stabilization
of both stable and unstable intertrochanteric fractures
Cephalomedullary fixation

This technique, however, led to ex

cessive external rotation and knee
pain and has been abandoned.
The use of antegrade nails inserted t
hrough the greater trochanter, with a
compression hip screw inserted throu
gh the proximal portion of the nail in
to the femoral head, is now being us
ed, especially for unstable fracture pa
tterns
Daftar pustaka

1. https://emedicine.medscape.com/article/1247210-overview#a12
2. https://www.orthobullets.com/trauma/1038/intertrochanteric-fractures
3. http://traumainternational.co.in/classifications-intertrochanteric-fractures-clinic
al-importance/