There is a greater trochanter on the outside and a lesser trochanter on the opposite side. The anterior and medial reduction of intertrochanteric. However, despite wide use of flexible fracture fixation, rigid fracture fixation with plates and screws still has an important place and is desirable for fractures that involve an articular surface. Aug 02, 2017 an intertrochanteric fracture is a specific type of hip fracture. A lucency, representing the fracture, runs between the two trochanters white arrows. Complex pertrochanteric fractures have an additional fracture. Feb 06, 2020 the stability of an intertrochanteric fracture is defined by the amount of contact between the proximal and distal main fragments see the images below. The epub format uses ebook readers, which have several ease of reading features.
The fracture line passes between the two trochanters, above the lesser trochanter. The fracture was subsequently diagnosed using mri and surgically fixed. Intertrochanteric fractures in younger individuals are usually the result of a highenergy injury, such as a motor vehicle accident or. Femur, intertrochanteric fractures, cephalomedullary nail. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Mri continues to be the gold standard for diagnosing occult hip fractures in the acute setting. Intertrochanteric femur fractures introduction hip fractures can be divided into two groups. The leading introductory radiology text for medical students and others who are required to read and interpret common radiologic images, learning radiology, 4th edition, stresses. The boyd and griffin scale was the first system to attempt to classify these fractures but since simpler evans and ao classifications have also been proposed.
Fracture healing under flexible fixation typically occurs by means of callus formation. Investigation of hip injury summary radiology reference article. To present the imaging findings and treatment options for incomplete intertrochanteric fractures. The anterior and medial reduction of intertrochanteric fractures. Smartdraw includes s of professional healthcare and anatomy chart templates that you can modify and make your own. In the radiologic outcomes, adequacy of reduction, tipapex distance and. An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to. Intertrochanteric fractures of the femur, besides presenting all the usual problems of fracture healing, have some unique features because of the particular anatomical site involved. Parallel screw fixation of a femoral neck fracture with cannulated screws.
Hip fractures are associated with a substantial mortality, as many as 1520% dying within one year of. A twopart fracture is very stable because once the two fragments are reduced, they are impacted on each other and provide inherent stability for the implant. There is a fracture from the greater red arrow to the lesser green arrow trochanter. Fractures are not always identified on initial xray imaging. Pdf classifications of intertrochanteric fractures and. Between march 1, 2005, and july 31, 2006, 100 consecutive patients with an intertrochanteric fracture were treated with a new trochanteric antegrade nail intertan. Lower limb is the focal point of this medical video lecture. Open reduction internal fixation orif with intra or extramedullary implants is the most frequent attitude in these fractures, which usually heal easily. The medical community divides the femur into multiple different regions and a fracture can occur in any of these areas. Femoral head femoral shaft trochanteric fracture intertrochanteric fracture gamma nail these keywords were added by machine and not by the authors. Listen to the audio pronunciation in the cambridge english dictionary. A hip fracture is a break in the upper quarter of the femur thigh bone.
Cervicotrochanteric fractures with a fracture line at the base of the femoral neck b. Alright, now in this part of the article, you will be able to access the free pdf download of handbook of fractures 5th edition pdf using our direct links mentioned at the end of this article. The incidence of intertrochanteric fracture has increased during recent years as life expectancy has also increased. Handbook of fractures 5th edition pdf free download direct link. Classifications of intertrochanteric fractures and their. In cases of unstable intertrochanteric fracture in the elderly, osteoporosis and comminution. Learning radiology 9780323567299 us elsevier health bookshop. Create healthcare diagrams like this example called evans classification of intertrochanteric fractures in minutes with smartdraw. If there is a clinical concern for a hip fracture, but the xray is normal, further imaging is required. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. For type of fracture, knee pain was more common with intertrochanteric fracture than with femur neck fracture 48. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. In the early 1990s, a new method of an intramedullary nail in the proximal femur with an interlocking screw in the femoral head was introduced2,9.
Cardiac radiology genitourinary radiology learning radiology. You may not embed one of our images on your web page without a link back to our site. Recent trochanteric fracture is frequent in adults, and mainly affects elderly patients who risk loss of independence. Woman with intertrochanteric femur fracture diagnosed by mr. Management of intertrochanteric fractures of the femur. A special type of screw that is used in the treatment of intertrochanteric proximal femur fractures is called a dynamic compression screw device. Feb 06, 2020 intertrochanteric fractures are considered 1 of the 3 types of hip fractures. We present the case of an elderly woman who sustained an intertrochanteric hip fracture from a fall, with negative findings on plain film. Radiographs on admission fig 1, a and b showed a comminuted intertrochanteric fracture with displacement of the lesser trochanter medially. The extent of the break depends on the forces that are involved. This process is experimental and the keywords may be updated as the learning algorithm improves. Simple pertrochanteric fractures fracture line that runs parallel to the intertrochanteric line. Fracture fixation radiographics rsna publications online. A hip fracture is a break that occurs in the upper part of the femur thigh bone.
If neither of these is fractured, the fracture is termed a two part fracture. Management of intertrochanteric fractures of the femur preston a. Other osteoporosis with current pathological fracture, right femur, initial encounter for fracture. Comminuted intertrochanteric fracture jama jama network. Fractures of the proximal femur learning radiology. Aug 28, 2014 older individuals who sustain an intertrochanteric fracture as a result of a lowenergy fall occasionally have an associated osteoporosis related fracture, such as a distal radius or proximal humerus fracture. Surgical results of the cephalomedullary nail for the femoral. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. If you would like a large, unwatermarked image for your web page or. Intertrochanteric femur fractures orthopaedicsone articles. Orthopedic hardware uw radiology university of washington. Learning radiology fractures of the proximal femur. Pelvic xrays are a key component of trauma, fractures and. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur.
An unstable intertrochanteric fracture of the hip is a fracture that has the potential to displace or result in nonunion despite what appears to be adequate reduction and internal fixation. Extra capsular fractures which involve the femoral trochanters include intertrochanteric and subtrochanteric fractures. Among 31 patients with the magnetic resonance mr imaging diagnosis of incomplete intertrochanteric fracture, 30 also underwent radiography. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. Aug 17, 2017 intertrochanteric fracture of the femur. The type of surgery used to treat a hip fracture is primarily based on the bones and soft tissues affected or on the level of the fracture. Any elderly patient presenting with hip pain following a fall or other trauma must be. Intertrochanteric fractures are a common injury of the proximal femur, and are classed as an extracapsular femoral neck fracture. Intertrochanteric fractures account for about 50% of proximal femur fractures egol 2010 female to male ratio is 3. Handbook of fractures 5th edition pdf free download. Neck of femur fractures nof are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral. Unknown case 2 on an awardwinning site aimed at medical students and radiology residentsintraining, containing powerpoint lectures, handouts, images.
Evans classification of intertrochanteric fractures. Apr 05, 2015 intertrochanteric fracture classification by kyle 7. Fractures of the proximal femur femoral neck fractures. Intraarticular fractures of the distal radius malone classification. The lateral image shows a step in the cortex anteriorly and angulation of the femoral shaft. However, i do expect you to learn the general name and function of each device. An intertrochanteric fracture is a specific type of hip fracture.