Essay 25- Pertrochanteric fractures
Definition
- Trochanter fracture where the fracture line passes through the major trochanter but both trochanters can be affected and most often the fracture is fragmented!
- They are a type of extracapsular fracture.
Etiology
- Most are the result of a traumatic event, such as a fall or direct impact to the hip
- Direct or indirect or by torsion-flexion!
- Osteoporosis (weakens bones)
Symptoms
Mechanism:
- Direct : fall on greater trochanter
- Indirect : force along its axis via torsion-flexion mechanism
- Massive hematoma
- Pain
- Swelling
- External rotation and shortening of extremity
- Inability to move affected hip
- Inability to bear weight on affected leg
- Positive “nailed heel” symptom
DIAGNOSIS
X-rays are performed face and profile projections to confirm the diagnosis.
- In the face projection; the X-Ray reveals the type of fracture and degree of dislocation.
- In the profile projection; the x-ray helps to clarify the dislocation
Treatment
- Can be conservative or surgical
- Main aim is to create conditions for fast and early mobilisation and resumption of function
MENT:
- Conservative treatment
- ↪ for terminally ill elderly patients w/ contraindications due CO-morbidities
- A continuous extension (pass a wire through tibial tuberosity) is done in such patients for 2 months;
- Then they are verticalized with crutches, must not burden the extremity till after the 4th month.
- The 'position treatment' with a plaster fin; can cause though → decubitus in the sciatic region.
- Surgical treatment most commonly involves open reductions and internal fixation (ORIF) such as plates and screws for stable osteosynthesis.
- Closed reductions can be done via Ender's method (place 2-3 elastic splints via medial femoral condyle to the femoral neck under X-ray control).