Greater Trochanteric Fracture in Stable Intertrochentric Fracture

ISSN: 2320-5407 Int. J. Adv. Res.
9(08), 306-309
`Journal Homepage: - www.journalijar.com
Article DOI: 10.21474/IJAR01/13265

DOI URL: http://dx.doi.org/10.21474/IJAR01/13265
RESEARCH ARTICLE
GREATER TROCHANTERIC FRACTURE IN STABLE INTERTROCHENTRIC FRACTURE
Dr. Ahmed Alsarhani

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Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Background : stable intertrochentric femur with displaced greater
Received: 10 June 2021 trochanter is uncommon fracture pattern . intertrochentric femur
Final Accepted: 14 July 2021 fractures are associated with high morbidity and mortality , affecting
Published: August 2021
both genders ,with different complexity
Case report ; in our case report we have 75 years old male patient with
history of fall sustained intertrochentric femur fracture with displaced
greater trochenter treated with fixation of both fracture element Using
dynamic hip screw (DHS) with trochentric stabilizing plate (TSP) in
addition to tension band fixing the greater trochenter
Discussion : different pattern of intertrochentric femur fracture require
thorough planing for optimum management .intertrochentric femur
fracture with displaced greater trochanter need further research to
identify the best management option specially regard of functionality.
Copy Right, IJAR, 2021,. All rights reserved.

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Introduction:-
Intertrochanteric fractures are defined as extra-capsular fractures of the proximal femur that occur between the
greater and lesser trochanter.
The greater trochanter serves as an insertion site for the gluteus medius, gluteus minimus, obturator internus,
piriformis, and site of origin for the vastus lateralis. [6]
Intertrochanteric (IT) femur fractures are a very common injury seen in the elderly.[1]
Predisposing patient to morbidity and increased risk of mortality .managing such fracture surgically aimed to reduce
patient mortality and morbidity by restoring hip functionality and mobility [2]
Isolated GT fracture with no evidence of intertrochentric extension by MRI is treated conservatively in vast majority
of patient with noticed difference in strength [3]
In other hand intertrochentric extension of such fracture raise the need of surgical management
Case presentation
Case report of patient with 75 years old male patient known history of diabetes ,hypertension . patient Presented to
ER , with typical history of fall down ( slipped in wet surface 1 day prior to presentation) complaining of sever right
hip pain and inability to bear weight
Examination
vitally stable patient ,oriented and alert.
306
Corresponding Author:- Dr. Ahmed Alsarhani
ISSN: 2320-5407 Int. J. Adv. Res. 9(08), 306-309
Right lower limb in external rotation slight shortening further examination were unremarkable xray of the pelvis and
hip showed : intertrochentric femur fracture and displaced greater trochentric (GT).
figure (1) :- figure (2):-
Management
Patient was optimized medically , And underwent dynamic hip screw (dhs) fixation displaced GT had good bone
quality and intact attachment of gluteus medias and Maximus
We elected to go for dhs+tsp and tension band fixation . operation went smoothly with no complication intra-
operatively.
Follow up
Post operatively were uneventful patient was followed in hospital and started physiotherapy next day .
Patient was discharged day 6 post operatively , Mobilizing as tolerated with the assistance of frame walker .
[pst op day 5 follow up patient was mobilizing with assistance abduction of right hip actively measured at 15 degree
with 4/5 strength .
Left side hip abduction measured at 30 actively 5/5 strength .
2 weeks follow up radiologically good alignment . abduction of right hip actively measured at 30 degree with 5/5
strength .
Left side hip abduction measured at 30 actively 5/5 strength.
figure (3) :- figure (4) :-
307
ISSN: 2320-5407 Int. J. Adv. Res. 9(08), 306-309
figure (5):-
Discussion :-
Intertrochentric femur fracture is common among older population 80% of trochentric fracture in elderly were
caused by indoors fall . [4]
Intertrochentric fracture has high morbidity and mortality rate .Mortality can reach to 21.2% in first year [2]. 5 years
mortality reported at 23% [5] With more male to female mortality.
Carful evaluation and early management can reduce the risk of 1 year mortality and complication (including DVT
,pressure ulcers ,urinary tract infection ). [6]
The aim is to reduce morbidity and mortality in patient with intertrochentric fractures by optimizing Their medical
condition And considering suitable and stable fixation method , that promotes early mobilization .
Intertrichentric fracture is managed depending on fracture pattern and its inherent stability, as the failure rate is
highly correlated with the choice of implant and fracture pattern. Fractures with involvement of the lateral femoral
wall are considered an indication for intramedullary nailing and would not be treated with a sliding hip screw.
Unstable fracture patterns such as fractures with comminution of the posteromedial cortex, a thin lateral wall. [6]
In our cases we faced a question of wether to fix the intertrochentric fracture With DHS alone or to go for further
fixation aiming to produce superior functional outcome and faster rehabilitation. Decision was made to fix stable IT
fracture with DHS we opted to add tsp and augment with tension band .
Aiming to facilitate rehabilitation and avoid weakness in abduction which may cause further falls or limit patient
mobility predisposing him to further morbidity
Wether to fix similar fracture with stated method need further research ,
To find if it adds a further value in hip ROM, (range of motion), faster rehabilitation, limits pain.
Conclusion:-
similar fracture is un common , fixation of GT might improve the hip ROM , strength and overall mobilization ,
further research is needed to figure out the best management in such fractures
Acknowledgment:-
written consent were taken from the patient
References:-
1-kregor P.J., Obremeskey W.T., cruder H.J.,swiontkowski M.f., evidence-based orthopedic trauma working group
unstable pertrochentric femoral fracture .J orthop Trauma. 2005;19:63-66 [pubmed]
2-scott schnell,susanM,friedman MPH,stephan L.The 1-year mortality of patient treated in a hip fracture program
for elers.Geriatric prthop Sure Rehabil 2010;1(1):6-14[pubmed]
3-Ren, H., Huang, Q., He, J. et al. Does isolated greater trochanter implication affect hip abducent strength and
functions in intertrochanteric fracture?. BMC Musculoskelet Disord 20, 79 (2019). https://doi.org/10.1186/s12891-
019-2457-8
4- HaginoH, Endo N, Harada A, Iwamoto J, Mashiba T, Mori S, Ohtori S, SakaiA, Takada J, Yamamoto T.
308
ISSN: 2320-5407 Int. J. Adv. Res. 9(08), 306-309
J Orthop Sci. 2017 Sep;22(5):909-914. doi: 10.1016/j.jos.2017.06.003. Epub 2017 Jul 17.
PMID: 28728988
5- Quality of life after hip fracture surgery in the elderly.Fierens J, Broos PL
Acta Chir Belg. 2006 Jul-Aug; 106(4):393-6.
6- Attum B, Pilson H.2020 Aug 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.
PMID: 29630213.
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Greater Trochanteric Fracture in Stable Intertrochentric Fracture

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ISSN: 2320-5407 Int. J. Adv. Res.

`Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/13265

Dr. Ahmed Alsarhani

Copy Right, IJAR, 2021,. All rights reserved.

figure (1) :- figure (2):-

Left side hip abduction measured at 30 actively 5/5 strength .

Left side hip abduction measured at 30 actively 5/5 strength.

figure (3) :- figure (4) :-

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