Orif intertrochanteric fracture12/31/2023 ![]() Additionally, a physician-assisted AP traction view of the injured hip can be helpful in further characterizing fracture morphology and feasibility of closed reduction or need for open reduction techniques. MRI is indicated if there is an isolated greater trochanteric femur fracture and intertrochanteric extension is of concern. CT and MRI are typically not indicated but can be used if radiographs are negative, although the physical exam is consistent with a fracture. Full-length radiographs of the femur are useful to assess for deformities of the femur shaft which could affect the placement of an intramedullary nail and evaluation of prior implants in the distal femur. Although the diagnosis can be made without pelvic films, pelvic radiographs are useful to assist in preoperative planning for restoration of the proper neck-shaft angle. The recommended views include the anteroposterior (AP) pelvis, AP and cross-table lateral of the affected hip and full-length radiographs of the affected femur. Plain radiographs are the initial films chosen to evaluate for these fractures. In type II fractures, the A subclassification describes a 3 part fracture with a separate GREATER trochanter fragment while the B subclassification describes a 3 part fracture with a LESSER trochanter fragment. The A subclassification in type I fractures is used for non displaced fractures while B fractures are displaced. Type I is a 2 part fracture, Type II are 3 part fractures and Type III are 4 part fractures. ![]() This Evans classification breaks down intertrochanteric femur fractures based on displacement, number of fragments and the type of fragment displaced. Examples of unstable fractures include: comminution of the posteromedial cortex, a thin lateral wall, displaced lesser trochanter fracture, subtrochanteric extension and reverse obliquity fractures. Stable fractures have an intact posteromedial cortex and will resist compressive loads once reduced. Determination of stability is important as it helps determine the type of fixation required for stability. DOI: 10.4081/or.2012.These fractures are usually a result of a ground-level fall in the elderly population and are classified as either stable or unstable. The prognostic value of tip-to-apex distance (TAD index) in intertrochanteric fractures fixed by dynamic hip screw. A comparison of internal fixation and bipolar hemiarthroplasty for the treatment of reverse oblique intertrochanteric femoral fractures in elderly patients. ![]() Outcome of the dynamic helical hip screw system for intertrochanteric hip fractures in the elderly patients. Home-based leg strengthening exercise improves function one year after hip fracture: A randomized controlled study. ![]() A biomechanical study comparing helical blade with screw design for sliding hip fixations of unstable intertrochanteric fractures. The stability score of the intramedullary nailed intertrochanteric fractures: Stability of nailed fracture and postoperative patient mobilization. Management of hip fractures in the elderly: Evidence-based clinical practice guideline. American Academy of Orthopaedic Surgeons.In Brief: Fractures in brief: Intertrochanteric hip fractures. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. ![]()
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