Health Articles

Symptoms, Signs, and Classification
These fractures usually result from a fall, often on level ground. Physical examination of a displaced fracture shows the leg to be shortened and externally rotated from the pull of the leg muscles and gravity Hemorrhage from multiple bone fragments and associated soft tissue injuries can be extensive and may cause hypovolemic shock.
Intertrochanteric hip fractures are classified by the number of bony fragments and by the inherent stability (the ability to maintain continuity of the weight-bearing medial femoral cortex). Typically with two-part fractures, a single break slopes obliquely between the greater and lesser trochanters on the anteroposterior x-ray view (see FIG. 8-5). Three-part fractures also have a lesser trochanteric fragment, and four part fractures have a greater trochanteric fragment. As a rule, three-and four-part fractures are inherently unstable because of comminution of the medial femoral cortex. Fractures in the intertrochanteric region of the proximal femur usually allow adequate blood supply to all fragments; thus, osteonecrosis and nonunion rarely occur.
Treatment and Prognosis
Intertrochanteric hip fractures are treated by surgical stabilization unless an absolute medical contraindication exists or the patient is nonambulatory and demented, with limited pain perception. Traction does produce healing, but it usually takes 4 to 8 wk and introduces the risks of prolonged bed rest. Also, traction may not adequately control the deforming muscle forces around the hip, so that the bone may heal in a shortened and externally rotated position, producing a poor functional result.
The most common fixation device is the sliding compression hip screw, which provides rigid stabilization while impacting the fracture fragments, thus ensuring healing (see FIG. 8-6). Postoperatively, most patients can immediately begin full weight-bearing ambulation with a walker. Usually, they are able to use a cane in 6 to 12 wk.

Symptoms, Signs, and Classification
These fractures usually result from a fall, often on level ground. Physical examination of a displaced fracture shows the leg to be shortened and externally rotated from the pull of the leg muscles and gravity Hemorrhage from multiple bone fragments and associated soft tissue injuries can be extensive and may cause hypovolemic shock.
Intertrochanteric hip fractures are classified by the number of bony fragments and by the inherent stability (the ability to maintain continuity of the weight-bearing medial femoral cortex). Typically with two-part fractures, a single break slopes obliquely between the greater and lesser trochanters on the anteroposterior x-ray view (see FIG. 8-5). Three-part fractures also have a lesser trochanteric fragment, and four part fractures have a greater trochanteric fragment. As a rule, three-and four-part fractures are inherently unstable because of comminution of the medial femoral cortex. Fractures in the intertrochanteric region of the proximal femur usually allow adequate blood supply to all fragments; thus, osteonecrosis and nonunion rarely occur.
Treatment and Prognosis
Intertrochanteric hip fractures are treated by surgical stabilization unless an absolute medical contraindication exists or the patient is nonambulatory and demented, with limited pain perception. Traction does produce healing, but it usually takes 4 to 8 wk and introduces the risks of prolonged bed rest. Also, traction may not adequately control the deforming muscle forces around the hip, so that the bone may heal in a shortened and externally rotated position, producing a poor functional result.
The most common fixation device is the sliding compression hip screw, which provides rigid stabilization while impacting the fracture fragments, thus ensuring healing (see FIG. 8-6). Postoperatively, most patients can immediately begin full weight-bearing ambulation with a walker. Usually, they are able to use a cane in 6 to 12 wk.