Subtrochanteric and distal femur fractures in a patient. Free fulltext pdf articles from hundreds of disciplines, all in one place. Subtrochanteric fractures seinsheimer classification. The lesser trochanter is itself fractured and separated from the femur. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. Oct 17, 2018 a universally accepted fracture classification does not exist for subtrochanteric femur fractures. Feb 03, 2016 it had 44 patients who underwent surgery for a subtrochanteric fracture between january 2008 and december 20, and were available for at least one year of followup. Currently, most subtrochanteric fractures in which the piriformis fossa or greater trochanter are intact can be successfully treated with a cephalomedullary device. Other definitions include fractures from the lesser trochanter to the junction of the proximal and middle third of the femur. Challenges in subtrochanteric femur fracture management. Spontaneous subtrochanteric femoral stress fracture related. A locking plate was used to fix the distal femur fracture, enhancing the construction stability figures 4 and 5. T1 weighted and t2 weighted magnetic resonance images of upper femur showing signal changes in the marrow at the level of the.
Previously, nonsurgical treatment of these fractures was associated not only with significant shortening and malrotation but also with the morbidity and mortality of prolonged immobiliza. Older adults can fracture their femur from a fall because their bones tend to be weaker. Subtrochanteric medical definition merriamwebster medical. Prophylactic bilateral intramedullary femoral nails for. Subtrochantericintertrochanteric fractures, including any subtrochanteric fracture with extension through the greater trochanter. Subtrochanteric femur fractures orthopaedicsone articles. Classification based on the number of fragments and location and pattern of the fracture. The femur has a tuberosity termed the greater trochanter on one side with the lesser trochanter on the other side. The treatment of femoral subtrochanteric fractures with. Introduction subtrochanteric femur fractures in children are relatively uncommon. Tips for avoiding malreduction with subtrochanteric femur fractures orthoclips. Subtrochanteric fractures of the femur sciencedirect. Apr 01, 2010 specifically, subtrochanteric fractures of the hip are increasingly being diagnosed.
Limb elevated on radiolucent foam ramp or triangular wedge. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Collinge introduction subtrochanteric femur fractures are challenging injuries to manage, and no single method of treatment is applicable to all fracture patterns. Reconstruction nail techniques are also used for deformity correction and stabilization of malunions, nonunions, and failed plate fixation of subtrochanteric femur fractures. Intertrochanteric fractures abstract treatment of intertrochanteric hip fracture is based on patient medical condition, preexisting degenerative arthritis, bone quality, and the biomechanics of the fracture configuration.
A prospective randomised study comparing anatomical reduction and medial displacement osteotomy. When fracture occurs in the subtrochanteric portion of the femur, a displacement will be frequently found. This diagram illustrates and provides radiographs of an example of intramedullary fixation of a subtrochanteric femur fracture. Subtrochanteric fractures warrant special attention due to the biomechanical characteristics of this skeletal region and the muscle forces acting on the main fracture fragments. These fractures behave differently from other proximal femoral fractures and have their own management pitfalls and. During the last 50 years, the treatment of subtrochanteric femur fractures has evolved with improved understanding of both fracture biology and biomechanics.
Bisphosphonates and fractures of the subtrochanteric or. Salterharris type i physeal fracture of upper end of femur s79. The subtrochanteric portion of the femur is the stress concentration of the leg because of the group of surrounding muscles. One commonly accepted definition is that it includes fractures that involve the lesser trochanter and extend distally up to 5 cm. The typical deformity of the subtrochanteric femur fracture is one of external rotation and abduction of the.
Fixation of subtrochanteric fractures pdf paperity. Doctor answers on symptoms, diagnosis, treatment, and more. Skeletal traction through a distal femoral pin is useful in restoring the fracture length. Fracture may also occur at the site of screw placement for a femoral neck fracture if the inferior screw is placed too low as this creates a cortical defect and stress riser.
Apart of the choices of implant used, patient positioning for intramedullary nailing of subtrochanteric femoral fracture plays a crucial role in fracture reduction and should be considered during preoperative planning. Malunion, nonunion, and implant failure are several of the more. T1 weighted and t2 weighted magnetic resonance images of upper femur showing signal changes in the marrow at the level of the periosteal reaction. Cumulative incidence of classical hip and nonclassical subtrochanteric and diaphyseal femur fractures in alendronate exposed patients and matched controls. Spontaneous subtrochanteric femoral stress fracture related to alendronate.
The diagnosis was a subtrochanteric fracture of the right femur ao. Introduction subtrochanteric fractures account for 1034% of hip fractures 1, a wide reported range mainly. The occurrence of fracture of the subtrochanteric or diaphyseal femur was very rare, even among women who had been treated with bisphosphonates for as long as 10 years. Ipsilateral fracture of the femoral shaft, although more common in association with femoral neck fractures, should be ruled out in cases of high energy trauma. Although it is widely used and recommended by the ota, the ao classification has the disadvantage of including the subtrochanteric fracture in a group of fractures with different mechanical and biological behavior. To study the outcome of subtrochanteric hip fractures treated with proximal lateral femur locking plate. This content is intended for health care professionals in the united states. Fracture healing was obtained for all cases in a mean time of 11.
Subtrochanteric fracture after free vascularised fibular. In terms of infection, both deep and superficial surgical site infections can occur following operative treatment of st femur fractures. Nonunion, failure of the fracture to heal, is common in fractures of the neck of the femur, but much more rare with other types of hip fracture. Sep 26, 2017 the femur is broken up into different parts including the femoral head, the femoral neck, and the femoral shaft. This study aimed to investigate the impact on nonunion of the extent of comminution and postoperative displacement in patients surgically treated for subtrochanteric fractures. To study the outcome of subtrochanteric hip fractures treated.
In a true subtrochanteric fracture pattern, the mobile proximal fragment is displaced in a flexed, abducted and externally rotated position. Subtrochanteric hip fractures clinical presentation. Pdf subtrochanteric femur fracture treated by intramedullary fixation. Pdf reduction techniques for difficult subtrochanteric fractures. Device selection for internal fixation depends on the location of the fracture and degree of comminution 14 but, for subtrochanteric fracture after free vfg, the positions of the fibular graft and vessel pedicle are also important considerations. Tips for avoiding malreduction with subtrochanteric femur. Subtrochanteric femur fracture 3d reconstruction of the most inferior portion of a ct of the abdomen and pelvis reveals a comminuted subtrochanteric fracture of the right femur. Subtrochanteric femur fractures musculoskeletal key. Other fracture of head and neck of right femur, initial encounter for closed fracture. One type of femur fracture is termed a subtrochanteric femur fracture. An intertrochanteric fracture is a specific type of hip fracture. A total of 12 fractures in 10 patients were classified as occurring in the subtrochanteric or diaphyseal femur, a combined rate of 2. Subtrochanteric typically defined as area from lesser trochanter to 5cm distal.
The above image is a 3d reconstruction from the raw data of a ct of the abdomen and pelvis, such that the patient. Younger patients sustain a subtrochanteric fracture as a result of a highenergy injury and typically they have associated. For these fractures, the option of elastic nailing is appealing as it is minimally invasive with decreased surgical morbidity, decreased hospital stay, and earlier return. Depending on when this happened would help explain the findings. Assists in reducing fracture and matching flexion of distal fragment to proximal fragments flexion deformity. Subtrochanteric definition of subtrochanteric by medical. Subtrochanteric femoral fracture anatomy, classification and comparison of management options.
These will assist the physician to determine the optimal treatment. Transverse osteotomy was performed at the diaphyseal malunion and a long cefalomedullary nail was used to fix the subtrochanteric fracture, diaphyseal osteotomy, and distal femur fracture. Management of subtrochanteric proximal femur fractures. Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. Per and subtrochanteric femoral fractures request pdf. Subtrochanteric and diaphyseal femur fractures in patients. Jun, 2016 segmental fractures of the femur, in which the proximal fracture extends into the upper femoral metaphysis, are also good indications for reconstruction nails. A subtrochanteric femur fracture is a major bone fracture that could lead to the development of serious complications if not addressed quickly. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. University of north carolina chapel hill high compressiontension stress area with cantilever bend deformity.
The quality of fracture reduction proved to be the most important factor in bony union and time to union. Pathologic fractures, periprosthetic fractures and atypical fractures were excluded. Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. Subtrochanteric fracture of femur answers on healthtap. Treatment of subtrochanteric femur fractures using the dynamic condylar screw. From 2008 to 20, 44 patients with subtrochanteric fractures underwent surgery.
Subtrochanteric femur fractures are an uncommon injury in orthopedics, but when they are encountered they may present difficulties in management. Of particular concern are emerging reports of longterm bisphosphonate users presenting with unusual lowenergy subtrochanteric femur fractures. Oct 28, 2018 varus collapse of subtrochanteric femur fractures. Subtrochanteric and distal femur fractures in a patient with fem. Meanwhile, the distal locking screws were inserted using the free hand perfect circle technique. Proximal fixation is achieved through the use of cephalomedullary screws and distally with locked interlock screws. Jul 31, 2018 a broken femur is usually caused by a severe accident.
The definition of a subtrochanteric fracture for this study was any fracture of the femur in which the centre of the fracture line traversing the femur was within the 5 cm of bone distal to the results patient characteristics the average age of the patients was 74 years range, 2497, of whom 23 per cent were male. The arbeitsgemeinschaft fur osteosynthesefragenassociation for the study of internal fixation aoasif, along with the orthopaedic trauma association, developed a complicated threepart classification system with 10 subtypes see the image below. Subtrochanteric femur fractures result from a variety of mechanisms of injury and underlying pathologies. Subtrochanteric fractures account for approximately 1030% of all peritrochanteric fractures, and they affect persons of all ages. Subtrochanteric fractures of the femur jama surgery jama. These will assist the physician to determine the optimal treatment strategy and avoid. Radiograph of left hip showing a subtle periosteal reaction arrow. The healing rate of atypical subtrochanteric femur fractures treated with cephalomedullary nailing is lower than that previously reported for atypical femur fractures. Subtrochanteric femur fracture fixation remains one of the most challenging procedures to orthopedic surgeons. The progress of fracture healing, as well as the occurrence of.
Comminuted subtrochanteric fracture inferior to the greater and lesser trochanters. Following a fracture, powerful hip muscle forces often lead to complex but predictable deformities fig. Panel discussion from 10th annual philadelphia orthopaedic trauma symposium, june 2018. Mehta describes and identifies subtrochanteric fractures and the surgical implants currently available to treat these fractures. The purpose of this paper is to examine the recent literature on the epidemiology, classification, initial evaluation, and definitely treatment for these injuries. Meanwhile, the distal locking screws were inserted using the free hand.
Femoral head fractures femoral neck fractures intertrochanteric fractures subtrochanteric fractures femoral shaft fractures distal femur fractures 3. Outcomes currently, most subtrochanteric fractures in which the piriformis fossa or greater trochanter are intact can be successfully treated with a cephalomedullary device. The classic deformities are flexion provoked by the iliopsoas, abduction by the gluteus medius, and external rotation by the external rotators of the proximal fragment of the femur. Oct 29, 2014 subtrochanteric fractures warrant special attention due to the biomechanical characteristics of this skeletal region and the muscle forces acting on the main fracture fragments. A subtrochanteric femur fracture could be a serious injury. Review of the complete pathologic spectrum with emphasis on distinguishing imaging features michael j. Standard antegrade femoral nails may be indicated in certain fracture patterns.
Intertrochanteric fracture femur linkedin slideshare. The peritrochanteric fracture is one of the most serious causes of mortality and morbidity in the elderly. Pediatric subtrochanteric and supracondylar femur fractures can be challenging to treat due to instability and displacement of the short metaphyseal fragments, as well as limited remodeling potential of the proximal femur in subtrochanteric fractures and the pathologic nature of many supracondylar fractures 7, 10, 22, 26. The patient was placed in a supine position was set up on a fracture traction table after general anesthesia. The results obtained in 161 subtrochanteric fractures of the femur following treatment with a 95 degrees condylar blade plate or a dynamic condylar screw or a gamma nail were retrospectively analyzed. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. Subtrochanteric femur fractures have a bimodal age distribution. The management of pediatric subtrochanteric femur fractures. Pdf subtrochanteric fractures can result from highenergy trauma in young patients or from a fall or. Clinical and radiographic data were used to assess the outcome at 12 months. Special considerations reverse obliquity fractures are best treated as subtrochanteric fractures with either a 95 degree fixed angle implant or an intramedullary device. Subtrochanteric fractures are femoral fractures that occur below the lesser. Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw.
Spontaneous subtrochanteric femoral stress fracture. Healing of atypical subtrochanteric femur fractures after ce. Surgical technique for subtrochanteric fracture of femur wang. Abstract subtrochanteric femoral fractures are complicated injuries that may be associated with ot. Per convention, the subtrochanteric fracture is characterized as 1. The treatment of femoral subtrochanteric fractures with the proximal.
The above image is a 3d reconstruction from the raw data of a ct of the abdomen and pelvis, such that the patient did not have to undergo additional scanning and radiation exposure to get this image of the femur. Avascular necrosis of the femoral head occurs frequently 20% in intracapsular hip fractures, because the blood supply is interrupted. Intramedullary fixation of a subtrochanteric femur fracture. Callus is what we look for to show signs of healing. This diagram illustrates and provides a radiographic example of a subtrochanteric fracture varus nonunion. The results obtained in 161 subtrochanteric fractures of the femur following treatment with a 95 degrees condylar blade plate or a dynamic condylar screw or a. Seinsheimer classification for subtrochanteric fractures. Healing of atypical subtrochanteric femur fractures after. Please refer to table 2 for baseline demographics and table 3 for fracture. Surgical technique for subtrochanteric fracture of femur. Subtrochanteric fractures of the femur jama surgery. It varies in time before it becomes visible on an xray. Transepiphyseal fracture of femur icd10cm diagnosis code s72. Dec 29, 2016 the diagnosis was a subtrochanteric fracture of the right femur ao.
The right leg was placed in abduction while the left leg was positioned so that there was flexion of the knee and hip joint. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. The subtrochanteric region of the femur is an area of great stress concentration and, due to its muscular insertions, is subjected to several deforming forces. Treatment of intertrochanteric fractures of the femur. A hip fracture is a break that occurs in the upper part of the femur thigh bone. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. Subtrochanteric intertrochanteric fractures, including any subtrochanteric fracture with extension through the greater trochanter. The treatment of femoral subtrochanteric fractures with the.
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