Intertrochanteric femur fracture: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
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==Background== | ==Background== | ||
*Occur via fall in elderly or osteoporotic | *Occur via fall in elderly or osteoporotic | ||
{{Femur fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Hip pain DDX}} | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
{{Proximal femur fracture diagnosis}} | {{Proximal femur fracture diagnosis}} | ||
=== | ===Diagnosis=== | ||
[[File:Garden's Classification.jpg|thumb|Garden's classification of intertrochanteric fractures]] | [[File:Garden's Classification.jpg|thumb|Garden's classification of intertrochanteric fractures]] | ||
[[File:Cdm hip fracture 343.jpg|thumb|Intertrochanteric femur fracture.]] | |||
*Stable (Garden's type I and II) | *Stable (Garden's type I and II) | ||
**Lesser trochanter non-displaced, no comminution, medial cortices of prox/distal fragments aligned | **Lesser trochanter non-displaced, no comminution, medial cortices of prox/distal fragments aligned | ||
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==Management== | ==Management== | ||
* | {{General Fracture Management}} | ||
===Specific Management=== | |||
*Ortho consult | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit | ||
===Specialty Care=== | |||
*Typically requires ORIF | |||
==See Also== | ==See Also== | ||
Latest revision as of 18:15, 13 May 2021
Background
- Occur via fall in elderly or osteoporotic
Femur Fracture Types
Proximal
- Intracapsular
- Extracapsular
Shaft
- Mid-shaft femur fracture (all subtrochanteric)
Clinical Features
- Typically pain, swelling, ecchymosis
- May lose 1-2L of blood
- Unable to bear weight
- Shortening and external rotation if fracture is significantly displaced
Differential Diagnosis
Hip pain
Acute Trauma
- Femur fracture
- Proximal
- Intracapsular
- Extracapsular
- Shaft
- Mid-shaft femur fracture (all subtrochanteric)
- Proximal
- Hip dislocation
- Pelvic fractures
Chronic/Atraumatic
- Hip bursitis
- Psoas abscess
- Piriformis syndrome
- Meralgia paresthetica
- Septic arthritis
- Obturator nerve entrapment
- Avascular necrosis of hip
Evaluation
Workup
- Consider AP pelvis in addition to AP/lateral views to compare contralateral side
- Consider MRI if strong clinical suspicion but negative x-ray
Diagnosis
- Stable (Garden's type I and II)
- Lesser trochanter non-displaced, no comminution, medial cortices of prox/distal fragments aligned
- Unstable (Garden's type III and IV)
- Displacement occurs, comminution is present, or multiple fracture lines exist
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Ortho consult
Disposition
- Admit
Specialty Care
- Typically requires ORIF