Director of fracture service, cincinnati general hospital cincinnati, ohio subtrochanteric fracture of the femur is one of the major problems in the management of. Subtrochanteric fixation stability depends on discrete. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Apr 01, 2010 specifically, subtrochanteric fractures of the hip are increasingly being diagnosed. The 5 compression screwplate is inappropriate for stabilization of subtrochanteric femoral fractures since. A hip fracture is a break that occurs in the upper part of the femur thigh bone. Failure of the implant and subsequent nonunion is still an issue, however, and limited evidence exists regarding the most appropriate treatment. A 59yearoldfemale was ad mitted to the massachusetts general hospital complaining of sharp pain and tenderness in her left thigh. Techniques of obtaining and maintaining reduction during. The purpose of this case report was to demonstrate the use of physical therapy in regaining. Bisphosphonate therapy is commonly employed in the.
Full text bilateral subtrochanteric femoral fractures in. Subtrochanteric fractures of the femur jama surgery. Subtrochanteric femur fractures are an uncommon injury in orthopedics, but when they are encountered they may present difficulties in management. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk.
Fracture ofthemonth 15 number subtrochanteric fracture in a patient with pagets disease otto e. Subtrochanteric fractures of the femur sciencedirect. A subsequent study by abrahamsen examined 39,567 patients who used alendronate and found an incidence of 0. She was known to have had pagetsdisease for many years. The subtrochanteric region of the femur is one of the strongest parts of the femur and is unlikely to fracture in lowenergy trauma unless extreme osteoporosis is present. However, this anatomical classification of subtrochanteric fracture has several variations 33 34, resulting in variable definitions in published studies 26,30 35. Ender rod versus compression screw fixation of hip fractures. Transverse osteotomy was performed at the diaphyseal malunion and a long cefalomedullary nail was used to fix the subtrochanteric fracture, diaphyseal osteotomy, and distal femur fracture. A reduced bone turnover rate may lead to delayed bone healing. Detroit, michigan army of the united states t he treatment of intertrochanteric fractures of the femur has been recentiy we11 summarized by stuck. The updated report from sweden10 identified 172 atypical femur fractures among 5475 subtrochanteric and femoral shaft fractures 3. Subtrochanteric and distal femur fractures in a patient. Subtrochantericfractures of the femur jbjs august 2009 clamp assisted reduction of high.
The purpose of this case report was to demonstrate the use of physical therapy in regaining strength, range of. Further, severity of a subcapital fracture is graded by the garden classification of hip fractures. Improved understanding of the biomechanics of this region has shifted treatment toward the use of intramedullary devices imd as the shorterlevered arm on the proximal fixation results in greater load sharing and less bending movement across the fracture and implant. Pdf the treatment of intertrochanteric fractures of the. Subtrochanteric femur fractures introduction subtrochanteric fractures are fractures that occur in a zone extending from the lesser trochanter to 5cm distal to the lesser trochanter, however extension into the intertrochanteric region is common. Salterharris type i physeal fracture of upper end of femur s79. Extra capsular fractures which involve the femoral trochanters include intertrochanteric and subtrochanteric fractures. Threepart spiral fractures of the proximal third of the femur, in which the third part is a butterfly fragment type iv. Full text bilateral subtrochanteric femoral fractures in a.
The peritrochanteric fracture is one of the most serious causes of mortality and morbidity in the elderly. Subtrochanteric femur fractures orthopaedicsone articles. Other fracture of head and neck of left femur, initial encounter for closed fracture. Modified unipolar hemiarthroplasty for the treatment of.
Subtrochanteric fractures have been defined as occurring in a zone extending from the lesser trochanter to 5 cm distal to the lesser trochanter 32. Subtrochanteric with intertrochanteric extension with the fracture lying in atleast two planes 30. Subtrochanteric and distal femur fractures in a patient with fem. Subtrochanteric fractures warrant special attention due to the biomechanical characteristics of this skeletal region and the muscle forces acting on the main fracture fragments. Subtrochanteric fixation stability depends on discrete fract.
Original article treatment of subtrochanteric fracture. Classification based on the number of fragments and location and pattern of the fracture. Apr 21, 2020 further, severity of a subcapital fracture is graded by the garden classification of hip fractures. Although subtrochanteric femur fractures comprise approximately 10% of the hip fractures seen in younger 46 and older populations, 29 they continue to be a challenge. Director of fracture service, cincinnati general hospital cincinnati, ohio subtrochanteric fracture of the femur is one of the major problems in the management of fractures. The lesser trochanter is itself fractured and separated from the femur. Certain fracture patterns can be well stabilized using the timetested 95 plates. Seinsheimer classification for subtrochanteric fractures. Fracture may also occur at the site of screw placement for a femoral neck fracture if the inferior screw is placed too low as this creates a cortical defect and stress riser. Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. Subtrochanteric intertrochanteric fractures, including any subtrochanteric fracture with extension through the greater trochanter. List of work group members pdf access via web application. Treatment of intertrochanteric fractures of the femur pdf.
A locking plate was used to fix the distal femur fracture, enhancing the construction stability figures 4 and 5. Revision of a nonunited subtrochanteric femoral fracture. Specifically, subtrochanteric fractures of the hip are increasingly being diagnosed. The treatment of intertrochanteric fractures of the femur with endovis nail article pdf available december 2011 with 337 reads how we measure reads. Avascular necrosis of the femoral head occurs frequently 20% in intracapsular hip fractures, because the blood supply is interrupted. Most fractures of the subtrochanteric region of the femur heal when treated using contemporary methods of internal fixation. A subtrochanteric femur fracture could be a serious injury. The quality of fracture reduction proved to be the most important factor in bony union and time to union. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. If you do not see its contents the file may be temporarily. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg.
She was known to have had pagetsdis ease for many years. Stabilizing subtrochanteric femoral fractures with an interlocked. Oblique view of the right pelvis demonstrates a comminuted subtrochanteric fracture inferior to the greater and lesser trochanters. Restoring functional mobility in an adult patient secondary. Subtrochanteric fractures account for approximately 1030% of all peritrochanteric fractures, and they affect persons of all ages. Subtrochanteric fractures of the femur jama surgery jama. The outcome in early cases of treatment of subtrochanteric. Healing of atypical subtrochanteric femur fractures after. Extensive studies have shown that therapy with bisphosphonates improves bone density and. Prophylactic bilateral intramedullary femoral nails for. Bilateral subtrochanteric femoral fractures in a previous alendronatemedicated patient. Subtrochanteric extension into lateral shaft, extension of the fracture distally at or just below the lesser trochanter the term reverse obliquity was coined bywright iv.
Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. The patients included in this study were those with subtrochanteric fractures ao type 32ac treated with pflcp synthes between jan 2009 and jun 2011. Request pdf subtrochanteric femur fractures subtrochanteric femur fractures are significant injuries that despite surgery can lead to relatively high rates of. Fracture healing was obtained for all cases in a mean time of 11. Sep 26, 2017 a subtrochanteric femur fracture is a major bone fracture that could lead to the development of serious complications if not addressed quickly. If neither of these is fractured, the fracture is termed a two part fracture. The intertrochanteric fracture is by far the most common and is classified according to the status of the lesser and greater trochanter. Oct 29, 2014 subtrochanteric fractures warrant special attention due to the biomechanical characteristics of this skeletal region and the muscle forces acting on the main fracture fragments. Atypical subtrochanteric fracture and femoral fracture have been considered to be rare complications related to longterm bisphosphonates use. Subtrochanteric fractures after longterm treatment with. Abstractobjective to study the outcome of subtrochanteric hip fractures treated with proximal. Fixation of subtrochanteric fractures pdf paperity. A subtrochanteric femur fracture is a major bone fracture that could lead to the development of serious complications if not addressed quickly. The treatment of femoral subtrochanteric fractures with the.
Furthermore, all of the people in the study already had one fracture, so those whose first fracture was a femur fracture would not have been included. Subtrochanteric fracture in a patient with pagets disease. Treatment of subtrochanteric femur fractures using the dynamic condylar screw. This case report accounts the outcomes of skilled physical therapy interventions for treatment of an intramedullary nail fixation of a subtrochanteric fracture. Spontaneous incomplete transverse subtrochanteric femoral. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Schatzker j, waddell jp 1980 subtrochanteric fractures of the femur. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone.
Subtrochantericintertrochanteric fractures, including any subtrochanteric fracture with extension through the greater trochanter. The femur is broken up into different parts including the femoral head, the femoral neck, and the femoral shaft. Comminuted fractures with four or more fragments type v. We report the case of an 80yearold caucasian woman with a subtrochanteric fracture originally treated using a trochanteric. A 59yearoldfemale was admitted to the massachusetts general hospital complaining of sharp pain and tenderness in her left thigh. Pdf hip arthroplasty after failed fixation of trochanteric. Nonunion, failure of the fracture to heal, is common in fractures of the neck of the femur, but much more rare with other types of hip fracture. Feb 06, 2020 the stability of an intertrochanteric fracture is defined by the amount of contact between the proximal and distal main fragments see the images below. Limited data have revealed that teriparatide treatment may reverse the effect of bisphosphonates and be effective in bone healing. In a true subtrochanteric fracture pattern, the mobile proximal fragment is displaced in a flexed, abducted and externally rotated position. There are over 15 described classifications for subtrochanteric fractures.
Of these factors, only quality of reduction and fixation stability can be controlled by the surgeon. The positive predictive value ppv was high for location of fractures in the subtrochanteric region versus femoral neck or intertrochanteric regions, but was very low for identifying a fracture as atypical. The subtrochanteric region of the femur is an area of great stress concentration and, due to its muscular insertions, is subjected to several deforming forces. An intertrochanteric fracture is a specific type of hip fracture. Finally, a long imhs was then inserted into the anatomically reduced femur in the normal fash ion.
Femoral subtrochanteric fractures are commonly treated using intramedullary devices. Subtrochanteric typically defined as area from lesser trochanter to 5cm distal. Treatment of intertrochanteric fractures of the femur. The treatment of these fractures can vary greatly depending on the age of the patient and the fracture pattern. Subtrochanteric and intertrochanteric treatment with plate orif peritrochanteric femur fractures extracapsular hip fractures involving the trochanter and frequent extension into the subtrochanteric region evaluate for pathologic fracture if radiographs or medical history indicate incidence elder patient population. Results of treatment with the 95 degrees condylar bladeplate. Full text full text is available as a scanned copy of the original print version. This article is from acta ortopedica brasileira, volume 20. The treatment of femoral subtrochanteric fractures with. Subtrochanteric fractures of the femur springerlink. Professor of clinical surgery, college of medicine, university of cincinnati. Jun 28, 2016 the updated report from sweden10 identified 172 atypical femur fractures among 5475 subtrochanteric and femoral shaft fractures 3. Simulated stable and unstable subtrochanteric femur fractures were created in composite femurs, anatomically reduced, fixed with either a long gamma nail or a blade plate, and subjected to combined axial.
Currently, most subtrochanteric fractures in which the piriformis fossa or greater trochanter are intact can be successfully treated with a cephalomedullary device. Atypical subtrochanteric and diaphyseal femoral fractures. These fractures tend to be associated with highenergy trauma in younger patients 29,34 and with poor bone stock related to metastatic or osteoporotic conditions 34,46 in older patients. Subtrochanteric fractures seinsheimer classification. Get a printable copy pdf file of the complete article 450k, or click on a page image below to browse page by page. The classic deformities are flexion provoked by the iliopsoas, abduction by the gluteus medius, and external rotation by the external rotators of the proximal fragment of the femur. Hip arthroplasty after failed fixation of trochanteric and subtrochanteric fractures article pdf available in acta orthopaedica 835. It had 44 patients who underwent surgery for a subtrochanteric fracture between january 2008 and december 20, and were available for at least one year of followup.
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