II. Pathophysiology

  1. Extracapsular Hip Fracture
    1. Contrast with Femoral Neck Fracture
  2. Mechanism of injury
    1. High speed accident
    2. Fall from height

III. Diagnosis

  1. See Hip Fracture
  2. Fracture line between greater and lesser trochanters
    1. Above Subtrochanteric Fracture
    2. Below Femoral Neck Fracture

IV. Management

  1. Evaluate for associated injuries (see pitfalls below)
  2. Closely manage fluid status
    1. Initial Resuscitation with isotonic crystalloid
    2. Type and Cross for 2 Units pRBC
    3. Continually reassess hemodynamic status
  3. Open reduction and internal fixation
    1. Surgery within 48 hours of injury

V. Complications

  1. Significant blood loss and hemodynamic instability

VI. Pitfalls

  1. Elderly are often significantly dehydrated
  2. Associated injuries are common
    1. Distal Radius Fracture
    2. Proximal Humerus Fracture
    3. Rib Fracture
    4. Spinal compression Fractures (esp. T12 and L1)

VII. Prognosis

  1. High mortality in first year: Up to 30%

VIII. References

  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60

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Related Studies

Ontology: Intertrochanteric Fractures (C0162385)

Concepts Injury or Poisoning (T037)
MSH D006620
ICD10 S72.14
SnomedCT 127287001
English Fractures, Intertrochanteric, Intertrochanteric frac femur, femur fracture intertrochanteric, fracture intertrochanteric, intertrochanteric fractures, femur fractures intertrochanteric, intertrochanteric fracture, intertrochanteric fracture of femur, intertrochanteric fracture of femur (diagnosis), fracture of neck of femur intertrochanteric, Intertrochanteric fracture of femur, Intertrochanteric fracture (disorder), Intertrochanteric fracture, femur; fracture, intertrochanteric, intertrochanteric; femoral fracture, Intertrochanteric Fractures
Portuguese Fraturas Intertrocantéricas
French Fractures transtrochantériennes, Fractures trans-trochantériennes
German Intertrochantäre Frakturen
Spanish Fracturas Intertrocanterianas, fractura intertrocantérea (trastorno), fractura intertrocantérea
Italian Fratture intertrocanteriche
Norwegian Intertrokantærfrakturer, Fractura intertrochanterica femoris, Intertrokantært brudd
Dutch femur; fractuur, intertrochantair, intertrochantair; femurfractuur, Fractuur, intertrochantere