Surgical Treatment of Femur Intertrochanteric and Subtrochanteric Fracture

Jong-Oh Kim; Tae-Ho Kim

doi:10.5371/jkhs.2010.22.1.1

Journal List > J Korean Hip Soc > v.22(1) > 1048661

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Kim: Surgical Treatment of Femur Intertrochanteric and Subtrochanteric Fracture

Review Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(1): 1-12.

Published online: 31 March 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.1.1

Surgical Treatment of Femur Intertrochanteric and Subtrochanteric Fracture

Jong-Oh Kim, MD, Tae-Ho Kim, MD^*

Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman's University School of Medicine, Seoul, Korea.

^*Department of Orthopedic Surgery, Sahmyook Medical Center, Seoul, Korea.

Address reprint request to Jong-Oh Kim, MD. Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman's University School of Medicine, 911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea. TEL: +82-2-2650-5276, FAX: +82-2-2642-0349, ewhamdos@korea.com

Received 27 July 2009 Revised 20 October 2009 Accepted 30 November 2009

Abstract

Femur intertrochanteric and subtrochanteric fractures are extracapsular hip fractures and they show a bimodal age distribution. Most hip fractures in young patient are subtrochanteric or basicervical fractures that are caused by high energy injury. Most of the hip fractures in old patients are intertrochanteric fractures related to osteoporosis and low energy injury. For proximal hip fractures, the muscles around the hip joint make reduction difficult and the position of the lag screws affects healing of the fracture. To lower the complications of these fractures, surgeons can use an appropriate implant along with performing good reduction and good lag screw positioning. We report here on our review of femur intertrochanteric and subtrochanteric fractures, the characteristics of compression hip screws, the intramedullary devices and the technical pitfalls.

Keywords: Femur, Intertrochanteric fracture, Subtrochanteric fracture, Compression hip screw, Intramedullary device

Figures and Tables

Fig. 1

Boyd and Griffin classification.

Fig. 2

Evans classification.

Fig. 3

OTA/AO classification.

Fig. 4

Trochanteric stabilizaing plate.

Fig. 5

Intramedullary device (A) Gamma nail (B) Intertrochanteric/Subtrochanteric nail (ITST) (C) Proximal Femoral Nail (PFN) (D) Proximal Femoral Nail-Antirotaion (PFNA).

Fig. 6

Z-effect.

Fig. 7

Fielding classification.

Fig. 8

Seinsheimer classification.

Fig. 9

Russel-Taylor classification.

Fig. 10

AO/ASIF classification.

Fig. 11

Deforming forces about a subtrochanteric femur fracture.

Fig. 12

Kuntscher technique.

Table 1

Variations on the Intramedullary-Type Hip Screw

^*ITST: Intertrochanteric-Subtrochanteric

^†PFN: Proximal Femoral Nail

^‡PFNA: Proximal Femoral Nail-Antirotation

References

1. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteric fractures: Are they same? Clin Orthop Relat Res. 1996. 330:166–172.

2. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect. 2004. 53:441–454.

3. Koval KJ, Cantu RV. Rockwood CA, Green DP, editors. Intertrochanteric fractures. Fracture in adults. 2004. 5th ed. Philadelphia: JB Lippincott;1793–1825.

4. La Velle DG. Crenshaw AH, editor. Fractures of hip. Campbell's operative orthopaedics. 2008. 11th ed. Philadelphia: Mosby Inc;3237–3285.

5. Lee SH. Treatment of intertrochanteric fracture of the femur. J Korean Hip Soc. 2005. 17:206–210.

6. Templeman D, Baumgaertner MR, Leighton RK, Lindsey RW, Moed BR. Reducing complications in the surgical treatment of intertrochanteric fractures. Instr Course Lect. 2005. 54:409–415.

7. Yang KH. Treatment of pertrochanteric fractures. J Korean Fract Soc. 2005. 18:76–82.

8. Evans EM. Trochanteric fractures; a review of 110 cases treated by nail-plate fixation. J Bone Joint Surg Br. 1951. 33:192–204.

9. Rha JD, Kim YH, Yoon SI, Park TS, Lee MH. Factors affecting sliding of the lag screw in intertrochanteric fractures. Int Orthop. 1993. 17:320–324.

10. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995. 77:1058–1064.

11. Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checjetts RG. Intertrochanteric femoral fractures. mechanical failure after internal fixation. J Bone Joint Surg Br. 1990. 72:26–31.

12. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res. 1980. 146:53–61.

13. Ahrengart L, Törnkvist H, Fornander P, et al. A randomized study of the compression hip screw and gamma nail in 426 fractures. Clin Orthop Relat Res. 2002. 401:209–222.

14. Kyle RF, Cabanela ME, Russel TA, et al. Fractures of the proximal part of the femur. Instr Course Lect. 1995. 44:227–253.

15. Babst R, Renner N, Biedermann M, et al. Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures. J Orthop Trauma. 1998. 12:392–399.

16. Bong MR, Patel V, Iesaka K, Egol KA, Kummer FJ, Koval KJ. Comparison of sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures: a cadaver study. J Trauma. 2004. 56:791–794.

17. Seong YB, Sohn YJ, Yum JG, et al. Intertrochanteric fracture of the femur treated with proximal femoral nail: long term results. J Korean Hip Soc. 2005. 17:141–148.

18. Hwang DS, Kwak SK, Woo SM. Results of cementless hemiarthroplasty for elderly patients with unstable intertrochanteric fractures. J Korean Hip Soc. 2004. 16:386–391.

19. Kim JH, Lee S, Jeong SY, Park JS, Seo YH. Bipolar hemiarthroplasty using the greater trochanter reattachment device (GTRD) for comminuted intertrochanteric fracture in elderly patients. J Korean Hip Soc. 2004. 16:441–446.

20. Goldhagen PR, O'Connor DR, Schwarze D, Schwartz E. A prospective comparative study of the compression hip screw and the gamma nail. J Orthop Trauma. 1994. 8:367–372.

21. Zuckerman JD. Comprehensive care of orthopedic injuries in elderly. 1990. Baltimore: Urbanand & Schwarzenberg.

22. Soballe K. Laceration of superficial femoral artery by an intertrochanteric fracture fragment. J Bone Joint Surg Am. 1987. 69:781–783.

23. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fractures in the elderly. Clin Orthop Relat Res. 1998. 348:22–28.

24. Baumgaertner MR, Chrostowski JH, Levy RN. Bowner BD, Levine AM, Jupiter JB, Trafton PG, editors. Intertrochanteric hip fracture. Skeletal trauma. 1992. vol 2. Philadelphia: WB Saunders;1833–1881.

25. Cheng CL, Chow SP, Pun WK, Leong JC. Long-term results and complications of cement augmentation in the treatment of unstable trochanteric fractures. Injury. 1989. 20:134–138.

26. Harrington KD. The use of methylmethacrylate as an adjunct in the internal fixation of unstable comminuted intertrochanteric fractures in osteoporotic patients. J Bone Joint Surg Am. 1975. 57:744–750.

27. Moroni A, Faldini C, Pegreffi F, et al. How to prevent fixation failure in patients with an osteoporotic trochanteric fractures treated with dynamic hip screw: a prospective randomized study. 2002. In : Annual OTA meeting;

28. Fielding JW, Magliato HJ. Subtrochanteric fractures. Surg Gynecol Obstet. 1966. 122:555–560.

29. Seinsheimer F. Subtrochanteric fractures of the femur. J Bone Joint Surg Am. 1978. 60:300–306.

30. Russell TA, Taylor JC. Browner BD, Jupiter JB, Levine AM, editors. Subtrochanteric fractures of the femur. Skeletal Trauma. 1992. Philadelphia: WB Saunders Co;1485–1524.

31. Yang KH. Correction of malalignment during subtrochanteric nailing. J Korean Fract Soc. 2009. 22:66–70.

TOOLS

Similar articles