Difference between revisions of "Intertrochanteric femur fracture"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
 
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==Management==
 
==Management==
*Admit for eventual ORIF
+
{{General Fracture Management}}
 +
 
 +
===Specific Management===
 +
*Ortho consult
  
 
==Disposition==
 
==Disposition==
 
*Admit
 
*Admit
 +
 +
===Specialty Care===
 +
*Typically requires ORIF
  
 
==See Also==
 
==See Also==

Latest revision as of 05:43, 18 September 2019

Background

  • Occur via fall in elderly or osteoporotic

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

Femur fractures

Proximal

Shaft

Evaluation

Location of femur fractures
  • Consider AP pelvis in addition to AP/lateral views to compare contralateral side
  • Consider MRI if strong clinical suspicion but negative x-ray

Evaluation

Garden's classification of intertrochanteric fractures
  • 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
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Specific Management

  • Ortho consult

Disposition

  • Admit

Specialty Care

  • Typically requires ORIF

See Also

External Links

References