Intertrochanteric femur fracture

Differential Diagnosis

Femur Fracture Types

Proximal

• Intracapsular
  • Femoral head fracture
  • Femoral neck fracture
• Extracapsular
  • Intertrochanteric femur fracture
  • Trochanteric femur fracture

Shaft

• Mid-shaft femur fracture (all subtrochanteric)

Diagnosis

Hip fracture classification.

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

References

Intertrochanteric

Garden's classification of intertrochanteric fractures

• Occur via fall in elderly or osteoporotic
• Typically pain, swelling, ecchymosis
  • May lose 1-2L of blood
• Unable to bear weight
• Shortening and external rotation if fracture is significantly displaced
• Types:
  • 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
  • Admit for eventual ORIF