Femoral intertrochanteric fracture is a common injury in the elderly, with the average age of patients being 5-6 years older than those with femoral neck fractures. Due to the abundant blood supply in the trochanteric region, nonunion is rare after the fracture, but hip varus is very likely to occur. Elderly patients who are bedridden for a long time are prone to developing complications.

bubble_chart Etiology

Elderly people are prone to fractures due to osteoporosis, and sudden twisting of the lower limbs or falls can easily cause fractures. The trochanteric region is subjected to varus forces, leading to coxa vara deformity.

bubble_chart Clinical Manifestations

Most patients are elderly, experiencing hip pain after injury and unable to stand or walk. Shortening of the lower limb and external rotation deformity are evident. For non-displaced impacted fractures or minimally displaced stable fractures, these symptoms are relatively mild. Examination may reveal elevation of the greater trochanter on the affected side, local swelling and bruising, with marked tenderness. Tapping the heel often causes severe pain at the injury site. Diagnosis is usually confirmed through X-ray examination, and classification is based on the X-ray findings.

bubble_chart Diagnosis

Obvious history of trauma, pain in the affected limb, and limited movement. X-rays can determine the location and displacement of the fracture.

bubble_chart Treatment Measures

Most patients are elderly, so the first priority is to monitor their overall condition and prevent life-threatening complications caused by prolonged bed rest after a fracture, such as pneumonia, bedsores, and urinary tract infections. The goal of fracture treatment is to prevent the occurrence of coxa vara deformity. The specific treatment method should be determined based on the type of fracture, degree of displacement, patient's age, and overall condition.

Applicable to all types of intertrochanteric fractures, especially for stable, non-displaced fractures in patients with severe internal organ diseases who are unsuitable for surgery. The advantage of traction is that it can control external rotation of the affected limb. For stable Type I and II fractures, traction is applied for 8 weeks, followed by joint mobilization and walking with crutches. However, weight-bearing on the affected limb should only begin after 12 weeks, once the fracture has healed firmly, to prevent coxa vara deformity.

For unstable fractures, the traction requirements are: a. Traction weight should be approximately 1/7 of the patient's body weight; b. Once the coxa vara deformity is corrected, a traction weight of 1/7 to 1/10 of the body weight must be maintained to prevent recurrence of the deformity; c. Traction should be maintained for a sufficient duration, generally exceeding 8–12 weeks, and discontinued only after the fracture has initially healed firmly.

2. Closed Multiple Steinmann Pins Internal Fixation via the Calcar

First, perform traction through the tibial tubercle for reduction, followed by a comprehensive systemic examination. Surgery is performed on the fracture table within 3–7 days after the injury. Four Steinmann pins with a diameter of 3.5mm are used, similar to the multiple Steinmann pin fixation technique for femoral neck fractures.

3. Nail-Plate Internal Fixation

This method is suitable for various types of fractures in adults. Commonly used internal fixation devices include the DHS (Dynamic Hip Screw) and the Charnley sliding compression screw.

4. Ender Nail Fixation

A hole is made 2cm above the medial femoral condyle, and Ender nails are inserted under X-ray fluoroscopy, passing through the fracture site to reach about 0.5cm below the articular surface of the femoral head. The tips of multiple nails are spread out in a fan or harpoon-like pattern to fix the proximal bone fragment. Postoperatively, skin traction or an anti-external rotation shoe is applied.

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

In the early 1990s, some countries adopted the Gamma nail, which consists of a locked intramedullary nail with a large screw obliquely inserted through the femoral head and neck. Since the main nail passes through the medullary cavity, biomechanical analysis shows that the force line is closer to the center of the femoral head. Therefore, the Gamma nail can withstand greater stress on the medial side of the femur, allowing for early weight-bearing.

bubble_chart Complications

pneumonia; bedsore; urinary tract infection