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Subtrochanteric Fracture
Aka: Subtrochanteric Fracture, Subtrochanteric Femur Fracture
- See Also
- Hip Fracture
- Pathophysiology
- Extracapsular Hip Fracture
- Contrast with Femoral Neck Fracture
- Mechanism of injury: Direct blunt Trauma
- High energy injury
- Gun shot wound
- Falls in the elderly
- Pathologic Fracture (Paget's Disease, Metastases)
- Diagnosis
- See Hip Fracture
- First 5 cm of femoral shaft below lesser trochanter
- Above Femoral Shaft Fracture
- Below Intertrochanteric Fracture
- Descriptive Classification
- Proximal or distal location
- Transverse or oblique angle
- Comminuted (common)
- Management
- Evaluate for associated injuries (see pitfalls below)
- Closely manage fluid status
- Initial Resuscitation with isotonic crystalloid
- Type and Cross for 2 Units pRBC
- Continually reassess hemodynamic status
- Open Reduction and Internal Fixation
- Pitfalls
- Significant blood loss
- From Hip Fracture or due to associated injuries
- Coexisting Fractures are common (up to 50%)
- Pelvic Fracture
- Vertebral Fracture
- High energy Trauma is associated with other injuries
- Thoracic Injury
- Abdominal Injury
- Complications
- Fat embolism
- Immobility associated morbidity
- Prognosis
- Mortality up to 20% due to comorbid injuries
- References
- Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
- Sims (2002) Orthop Clin North Am 33(1):113-26 [PubMed]