trochanteric fracture
TRANSCRIPT
Trochanteric fracture Gopisankar.M.G.
2008 MBBS
Occurs along a line between greater trochanter and lesser trochanter with variable comminution
Totally extracapsular
Four times more common than intracapsular
Age seen in elderly patients 10 – 12 years older than intracapsular # neck of femur
Sex f:m = 2.8 : 1
Clinical features
Pain in the hip
Marked shortening of the lower limb
Complete external rotation deformity
Swelling
Echymosis
Tenderness over the greater trochanter
X ray
Treatment
Conservative 10% mortality
Surgical
Conservative
Indication
1. Poor medical and surgical risk patients
2. Terminally ill patients
3. Very old patients
Methods
1. Simple support with pillows
2. Buck’s traction
3. Plaster spica
4. Skeletal traction through distal femur or tibia for 10 – 12 weeks
Buck’s traction
Hip spica
Traction using Bohler Braun frame
Surgical
10 fold rise in mortality if surgery is delayed for > 48 hrs.
Goal is to fix a stably reduced fracture internally
Methods of reduction
Closed Reduction traction , slight abduction and external rotation if cannot reduce open reduction done
Open Reduction indications
1. Failed closed reduction
2. Large spike on proximal fragment with lesser trochanter intact
3. Reverse oblique fracture
Reduction Anatomically /non anatomically
Implants
Dynamic Hip screw (DHS)
Proximal Femoral nails (PFN)
Dynamic Hip Screws
Proximal Femoral Nails
Complications
Malunion
Coxa vara
Traumatic Osteoarthritis