Trochanteric fracture Gopisankar.M.G.

2008 MBBS

Occurs along a line between greater trochanter and lesser trochanter with variable comminution

Totally extracapsular

Four times more common than intracapsular

Age seen in elderly patients 10 – 12 years older than intracapsular # neck of femur

Sex f:m = 2.8 : 1

Clinical features

Pain in the hip

Marked shortening of the lower limb

Complete external rotation deformity

Swelling

Echymosis

Tenderness over the greater trochanter

X ray

Treatment

Conservative 10% mortality

Surgical

Conservative

Indication

1. Poor medical and surgical risk patients

2. Terminally ill patients

3. Very old patients

Methods

1. Simple support with pillows

2. Buck’s traction

3. Plaster spica

4. Skeletal traction through distal femur or tibia for 10 – 12 weeks

Buck’s traction

Hip spica

Traction using Bohler Braun frame

Surgical

10 fold rise in mortality if surgery is delayed for > 48 hrs.

Goal is to fix a stably reduced fracture internally

Methods of reduction

Closed Reduction traction , slight abduction and external rotation if cannot reduce open reduction done

Open Reduction indications

1. Failed closed reduction

2. Large spike on proximal fragment with lesser trochanter intact

3. Reverse oblique fracture

Reduction Anatomically /non anatomically

Implants

Dynamic Hip screw (DHS)

Proximal Femoral nails (PFN)

Dynamic Hip Screws

Proximal Femoral Nails

Complications

Malunion

Coxa vara

Traumatic Osteoarthritis