Hip

Intertrochanteric Fracture

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Intertrochanteric Fracture

  • See Also
  • Pathophysiology
  1. Extracapsular Hip Fracture
    1. Contrast with Femoral Neck Fracture
  2. Mechanism of injury
    1. High speed accident
    2. Fall from height
  • Diagnosis
  1. See Hip Fracture
  2. Fracture line between greater and lesser trochanters
    1. Above Subtrochanteric Fracture
    2. Below Femoral Neck Fracture
  • 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
  • Complications
  1. Significant blood loss and hemodynamic instability
  • 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)
  • Prognosis
  1. High mortality in first year: Up to 30%
  • References
  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60