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intertrochanteric femur fractures

One of the most common fracture patterns in the setting of osteoporosis is the inter-trochanteric femur fracture.  This fracture is described as an inter-trochanteric pattern because the fracture lines occur in the area of the femur between the greater and the lesser trochanter.  The most common cause that results in this type of a fracture is a ground level fall in which the patient lands on the side of the hip on a hard surface, breaking the bone.  In the following X-rays, we are able to see the inter-trochanteric region of the normal femur, and there are also a couple of examples of relatively simple, and then progressively more complicated inter-trochanteric femur fractures.  You can click on any of the thumbnails to enlarge them and on the enlarged images the white dots trace the fracture lines.

intertrochanteric-region  inter-trochanteric-hip-fracture  hip-fracture-proximal-femur

 

Here is an image from the Google body browser with the intertrochanteric region of the femur annotated.  In this example, it is a right femur seen from behind the patient.

intertrochanteric region google body

Historically, the most common surgical procedure for fixing inter-trochanteric femur fractures was the dynamic hip screw, also known as the screw and slide plate.  This device resulted in a dramatic improvement over previous generations of orthopedic instrumentation and it tended to stimulate relatively reliable healing.  However, a newer generation implant — an intra-medullary device — often represents an even greater improvement.  This device — and the one that I use most frequently is called the Synthes Trochanteric Femoral Nail — is designed to be inserted through 2 or 3 small incisions and it reconstructs the weight bearing ability of the proximal femur by placing two interlocking titanium cylinders inside the bone marrow area of the femur.  In my hands, this device has been very reliable.  The small incisions typically heal completely, the fracture healing is very reliable, complications are few, and there rarely seems to be much concern over limb length inequality after fracture healing — which was almost always expected after surgical treatment with a screw and a side plate.

 

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