Subtrochanteric Fractures
Dr. Jamal Al-Saidy
M.B.Ch.B. .F.I.C.M.S
Within 5cm from lesser trochanter
in young adults large forces are needed to cause the fractures in this area.
in the elderly, the fracture quite frequently, the injury is relatively trivial; here
the reason is a weakening of bone in this area by:-
osteoporosis
osteomalacia
Paget’s disease
a secondary deposit
Blood loss is greater than with femoral neck or trochanteric fractures.
There may be subtle extensions of the fracture into the intertrochanteric
region.
The proximal part is abducted and externally rotated by the gluteal muscles,
and flexed by the psoas.
Clinical features
The leg lies in neutral or external rotation
looks short
the thigh is markedly swollen.
Movement is excruciatingly painful.
X-ray:-The fracture is through or below the lesser trochanter. It may be
transverse, oblique or spiral, and is frequently comminuted.
Treatment
Traction may help to reduce blood loss and pain, until the patient, is
stabilized and prepared for surgery.
Open reduction and internal fixation is the treatment of choice.
Two main types of implant are used for fracture fixation:
(a) an intramedullary nail with a proximal interlocking screw that can be
directed into the femoral head or placed in the standard manner
(b) a 95 degree hip screw-and-plate device.
Postoperatively the patient is allowed partial weightbearing (with crutches)
until union is secure.
Complications
Malunion Varus and rotational malunions are fairly common.
Non-union This occurs in about 5 per cent of cases.
THANK YOU
Dr. Jamal Al-Saidy
M.B.Ch.B. .F.I.C.M.S