II. Pathophysiology

  1. Extracapsular Hip Fracture
    1. Contrast with Femoral Neck Fracture
  2. Mechanism of injury: Direct blunt Trauma
    1. High energy injury
    2. Gun shot wound
    3. Falls in the elderly
    4. Pathologic Fracture (Paget's Disease, Metastases)

III. Diagnosis

  1. See Hip Fracture
  2. First 5 cm of femoral shaft below lesser trochanter
    1. Above Femoral Shaft Fracture
    2. Below Intertrochanteric Fracture
  3. Descriptive Classification
    1. Proximal or distal location
    2. Transverse or oblique angle
    3. Comminuted (common)

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

V. Pitfalls

  1. Significant blood loss
    1. From Hip Fracture or due to associated injuries
  2. Coexisting Fractures are common (up to 50%)
    1. Pelvic Fracture
    2. Vertebral Fracture
  3. High energy Trauma is associated with other injuries
    1. Thoracic Injury
    2. Abdominal Injury

VI. Complications

  1. Fat embolism
  2. Immobility associated morbidity

VII. Prognosis

  1. Mortality up to 20% due to comorbid injuries

VIII. References

  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
  2. Sims (2002) Orthop Clin North Am 33(1):113-26 [PubMed]

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Related Studies

Ontology: Subtrochanteric Fractures (C0162386)

Concepts Injury or Poisoning (T037)
MSH D006620
ICD10 S72.2
SnomedCT 208563005, 263229001
English Fractures, Subtrochanteric, Subtrochanteric fracture femur, subtrochanteric fracture, femur fractures subtrochanteric, subtrochanteric fractures, fracture of neck of femur subtrochanteric, subtrochanteric fracture of femur, subtrochanteric fracture of femur (diagnosis), Femur fracture subtrochanteric, Subtrochanteric fracture, Subtrochanteric fracture of femur, Subtrochanteric fracture of femur (disorder), femur fracture; subtrochanteric, femur; fracture, subtrochanteric, fracture; femur, subtrochanteric, subtrochanteric; femoral fracture, Subtrochanteric Fractures
Dutch subtrochantaire femurfractuur, femur; fractuur, subtrochantair, fractuur; femur, subtrochantair, heupfraktuur; subtrochantair, subtrochantair; femurfraktuur, Subtrochantaire fractuur, Fractuur, subtrochantere
French Fracture sous-trochantérienne du fémur, Fractures sous-trochantériennes
German Oberschenkelfraktur, subtrochantaer, Subtrochantäre Frakturen, Subtrochantaere Fraktur
Italian Frattura di femore subtrocanterica, Fratture sottotrocanteriche, Fratture subtrocanteriche
Portuguese Fractura do fémur subtrocanteriana, Fraturas Subtrocantéricas
Spanish Fractura subtrocantérea de fémur, Fracturas Subtrocanterianas, fractura subtrocantérica de fémur (trastorno), fractura subtrocantérica de fémur
Japanese 大腿骨転子下骨折, ダイタイコツテンシカコッセツ
Czech Subtrochanterická zlomenina femuru
Korean 전자하골절
Hungarian Subtrochanter femurtörés
Norwegian Subtrokantært brudd, Fractura subtrochanterica femoris, Subtrokantærfrakturer