Intertrochanteric femur fracture: Difference between revisions
(Created page with "==Background== ==Clinical Features== ==Differential Diagnosis== {{Femur fracture types}} ==Diagnosis== ==Management== ==Disposition== ==See Also== ==External Links== =...") |
|||
| (11 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Occur via fall in elderly or osteoporotic | |||
{{Femur fracture types}} | |||
==Clinical Features== | ==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== | ==Differential Diagnosis== | ||
{{ | {{Hip pain DDX}} | ||
==Evaluation== | |||
===Workup=== | |||
{{Proximal femur fracture diagnosis}} | |||
==Diagnosis== | ===Diagnosis=== | ||
[[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) | |||
**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== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Ortho consult | |||
==Disposition== | ==Disposition== | ||
*Admit | |||
===Specialty Care=== | |||
*Typically requires ORIF | |||
==See Also== | ==See Also== | ||
| Line 18: | Line 42: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | |||
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