The intertrochanteric femoral fractures, as well as the transcervical and the sub-trochanteric fractures, affect women over the age of 60, mainly after menopause, and are the most common fractures caused by falls.
What is the intertrochanteric fracture?
The intertrochanteric fracture, as the name suggests, is a diagonal fracture between the major and minor trochanter.
If the fracture is a little higher, it is called intra-capsular.
Each such fracture, depending on the amount of damage, is treated differently.
Intertrochanteric fractures occur during the fall phase. That is, the elderly person stumbles on a mat or small animal (pet) and rotates abruptly the femoral head in the hip joint, which due to osteoporosis breaks! That is, the femur bone breaks at this point due to reduced bone resistance (osteoporosis) and afterwards the person falls!
The trochanter region has a spongy bone texture, so after such a fracture the patient loses around the fracture, 3-4 units of blood!
At this age the sudden loss of such a quantity of blood is dangerous to human life. That’s why the patient needs to be rushed to hospital for treatment.
How is it diagnosed?
The intertrochanteric femoral fractures, as well as the transcervical and the sub-trochanteric fractures, are more “troublesome” fractures than the intra-capsular one. They cause more severe pain in leg movements. And in these fractures the foot is shorter and outward facing.
Patient transport should be careful. In a supine position we place a pillow between the thighs of the injured person and fasten the two legs together.
Transportation is safer with a stretcher or a type of stretcher.
How is it treated?
Fractures of the trochanter area (intertrochanteric femoral fractures, transcervical and sub-trochanteric fractures) need to be treated surgically as soon as possible.
A quick response is important, as the 70, 80, 90 or 100-year old patient, who up to that point was sufficiently functional, is suddenly disrupted by the fracture. He is lying on the ground, staring at the ceiling and beginning to lose consciousness. If we check his tongue in a few hours (due to the loss of the amount of blood mentioned) it is completely dry! That is why we should pressure him to drink small amounts of water from the first moment. We also need to lift the chest, so that he can breathe better.
The mortality in these ages, following an intertrochanteric fracture, is very high even for the best clinics worldwide. It is estimated that 25% of patients pass away very close to the fracture or some time afterwards. 25% are disabled and never return to their previous condition. 25% can move with some support (walking canes, strollers, etc.) and only 25% return to their previous state (International Statistics, 2012).
Femoral neck fractures are treated with surgery and Richard’s nailing.
Intertrochanteric femoral fractures and sub-trochanteric fractures are treated with a c-nail.
All patients receive anticoagulant therapy for 6 weeks and usually iron supplements to treat postoperative anemia. In the last few years before discharge, a dose of bisphosphonate is administered to treat osteoporosis (which has contributed to the size of the fracture).
- Intertrochanteric fracture
- Sub-trochanteric fracture
- Femoral neck fracture
- Richard’s nailing