Trochanteric Fractures

[Audio] Good morning everyone. Today, I will be discussing Trochanteric Fractures. These fractures occur in the proximal part of the femur and can be classified into intertrochanteric and subtrochanteric fractures. I will discuss the signs and symptoms, imaging studies, and classification systems associated with these fractures. I appreciate your attention..

[Audio] Fractures of the proximal part of the femur, known as the trochanter, are referred to as trochanteric fractures. They are more common in older adults and can be divided into two categories: intertrochanteric fractures located between the greater and lesser trochanters, where the gluteus medius and abductors, as well as the iliopsoas, or hip flexor, attach; and subtrochanteric fractures just below the lesser trochanter. These fractures are often associated with trauma and osteoporosis..

[Audio] Discuss Trochanteric Fractures of the femur, a type of fracture commonly affecting the proximal femur. These fractures normally occur due to high energy trauma from a fall onto a hard, flat surface, and can cause pain and mobility limitations. Treatment usually includes fixation with an IM nail or a compression hip screw and plate, in addition to engaging in physical therapy to recover strength and mobility..

[Audio] Mechanism of injury for trochanteric fractures differ among age groups. Younger individuals can often be traced to a major trauma, like a motor vehicle collision or falling from a great height. Elders are more often due to simpler falls. Generally, these fractures originate from direct impact to the greater trochanter area..

[Audio] When attempting to diagnose a patient with a history of localized proximal thigh pain and incapacitating fall or other injury, it is essential to take note of the pain being exacerbated by hip flexion or rotation. A thorough physical examination should be conducted to confirm diagnosis. We are currently discussing trochanteric fractures and the role of history and physical examination in diagnosis..

[Audio] Patients with trochanteric fractures often experience pain and find it hard to lift their leg. These individuals may also present with a marked shortening of the limb, external rotation deformity, abduction of the hip, edema, ecchymoses and tenderness at the greater trochanter. The severity of the deformity is usually correlated to the amount of displacement of the fracture..

[Audio] X-rays of the pelvis with both hips in anterior-posterior views should be the first step for imaging studies of trochanteric fractures. The affected hip should then be examined with X-rays in both anterior-posterior and cross-table lateral views. To aid in diagnosing comminuted and high-energy fractures, traction films with internal rotation may be taken. Additionally, femur X-rays in an anterior-posterior and lateral view should be taken for subtrochanteric extension..

[Audio] MRI is currently the imaging study of choice for delineating non-displaced or occult fractures that may not be apparent on plain radiographs, and it is preferred over CT due to its higher sensitivity and specificity for a faster decision-making process. Bone scans, on the other hand, are reserved for those who have contraindications to MRI. Specifically, technetium bone scans require two to three days to become positive..

[Audio] The Boyd and Griffin classification system for Trochanteric Fractures divides these fractures into four categories; Type 1 which is a nondisplaced intertrochanter fracture, stable in two parts; Type 2 which is a comminuted intertrochanteric fracture, stable with posteromedial comminution; Type 3 which is a comminuted intertrochanteric fracture with subtrochanteric extension, unstable reverse obliquity; and Type 4 which is an oblique fracture with extension into the subtrochanteric region, with the fracture lying in at least two planes..

InterTrochanteric Fractures.

[Audio] Dr. Basit Ali Abro has concluded his presentation on trochanteric fractures. Evan's classification of the fracture is divided into 6 distinct types which help differentiate stable and unstable features and to determine what can be considered as a stable reduction. We hope this presentation has been informative and educational. We appreciate your time and attention..