Subtrochanteric Fracture

Aka: Subtrochanteric Fracture, Subtrochanteric Femur Fracture

1. See Also
   1. Hip Fracture
2. 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)
3. 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)
4. 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
5. 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
6. Complications
   1. Fat embolism
   2. Immobility associated morbidity
7. Prognosis
   1. Mortality up to 20% due to comorbid injuries
8. 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]