Pdf our aim was to assess operative treatment for posttraumatic avascular necrosis of the. Full weight bearing, harris score of hip joint, complication. Pdf a study of management of trochanteric fracture of. Pdf operative treatment of avascular necrosis of the femoral head.
The guide wire for the hip screw must be placed centrally in the head on both the ap and lateral xrays. There are two major bursae in the hip that typically become irritated and inflamed. They are subdivided according to the number of fragments, as follows. Threefragment fracture without posterolateral support, owing to displacement of greater trochanter fragment type id. Inter trochanteric fractures, fracture shaft of femur. Avascular necrosis, femoral neck fracture, traumatology, imaging techniques, hip avn. A hip fracture is a break in the upper quarter of the femur thigh bone. Treatment of trochanteric and subtrochanteric hip fractures. Rigid lateral trochanteric entry trochanteric entry nail piriformis entry nail associated with avascular necrosis in children at a rate of 4% submuscular plating external fixation an option in open fractures or unstable fracture patterns higher complications rates. Fracture line extends upwards and outwards from the lesser trochanter stable. A femoral neck fracture occurs one to two inches from the hip joint. However there is a debate ongoing for what is the appropriate implant to use. A trochanteric fracture is a fracture involving the greater andor lesser trochanters of the femur.
A case of peritrochanteric fracture was also reported to be successfully operated with a dynamic interlocking trochanteric gamma nail. Avulsion fracture of the greater trochanter of the femur. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Two techniques for unstable intertrochanteric femoral fracture. Zuckerman jd, skovron ml, koval kj, aharonoff g, frankel vh. This study examined the pattern and extent of an injury shown by magnetic resonance imaging mri and radionuclide bone scan rbs in patients whose. One of the most serious sequelae of fnfs is avascular necrosis avn, which occurs in 1045% of patients with fnfs, particularly those who have displaced and nonunion fnfs.
Cleveland clinic is a nonprofit academic medical center. This type of fracture may cause a complication because the break usually cuts off the blood supply to the head of the femur which forms the hip joint. A fracture must be no more than 5cm below the lesser trochanter, otherwise it is treated as a femoral shaft fracture epidemiology of extracapsular neck of femur fractures much like intracapsular fractures, these are most commonly a fracture of elderly, osteoporotic bone. Intertrochanteric hip fractures clinical presentation. The greater trochanter is the bony prominence on the lateral aspect of the femur and is the insertion site for the hip abductors and external rotators. 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.
Proximal femoral fractures rsna publications online. Trochanteric nonunion may also increase the risk of prosthesis dislocation 2. Intertrochanteric femur fractures are one of the most serious causes of. Inflammation of this bursa is called trochanteric bursitis. Avascular necrosis and related complications following healed. Fractures in the inter trochanteric region of the proximal femur, involving either the greater or the lesser trochanter or both in elderly the fracture is sustained by a sideway fall or a blow over the greater trochanter. The term hip fracture is applied to fractures in any of these locations. When this bursa becomes irritated or inflamed, it causes pain in the hip. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. Using data from the norwegian hip fracture register in papers ii and iii, we analyzed 7643 operations for simple twopart trochanteric fractures aoota type a1 paper ii and 2716 operations for reverse oblique and subtrochanteric fractures paper iii after treatment with either a shs or an im nail. We followed prospectively 295 patients with trochanteric fractures treated with the proximal femoral nail.
Intertrochanteric fractures are considered 1 of the 3 types of hip fractures. Because of their purported rarity, greater trochanteric fractures have been included only incidentally, if at all, in most conventional hip fracture classifications 619. A hip fracture is a break that occurs in the upper part of the femur thigh bone. The incidence of avfh with a minimum of 1year followup was calculated 0. Surgical treatment of basicervical intertrochanteric fractures of the. Femoral neck fractures and intertrochanteric fractures often occur in elderly patients. Isolated fractures of the greater trochanter with occult. Trochanteric fractures treated with a proximal femoral. Greater trochanteric pain syndrome gtps has been defined as lateral hip pain to palpation of the peritrochanteric region. Trochanteric pain syndrome femoralacetabular impingement.
Fracture of the greater trochanter during hip replacement. Trochanteric and subtrochanteric femoral fractures constitute approximately 50% of all hip fractures. Treatment of recent trochanteric fracture in adults. Professor of radiology thomas jefferson university hospital philadelphia, pa usa bursitis greater trochanteric bursitis lateral fluid common. Therefore, early detection and classification of hip fractures are essential for guiding early appropriate treatment. During fluoroscopy, care was taken to ensure that all the screw threads crossed the fracture lines and compression was obtained at the femoral neck region. The trochanters are anatomical portions of the femur which serve as the attachment sites for several muscles. The greater trochanter is most vulnerable at its tip and upper portion, but its fracture mechanisms have been debated 10, 14, 15. Trochanteric fracture involves the proximal femur between the cervical region and the shaft. An unusual complication of total hip arthroplasty is fracture of the greater trochanter that occurs either intraoperatively or during the early postop period. No patient had evidence of avascular necrosis of the femoral head. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur.
Firstly, an experimental study was undertaken to confirm the applicability of rsa in trochanteric fractures. Brigham and womens hospital department of rehabilitation. Surgical treatment of basicervical intertrochanteric. The overall aim of the thesis was to evaluate the outcome in patients with stable. Avn of the femoral head is the most devastating complication following a pediatric hip fracture, and its incidence following injury is 40%, 27%, 20%, and 5% for fracture types i through iv respectively. Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. Recent trochanteric fracture in adults overwhelming affects elderly subjects. Isolated fractures of the greater trochanter gt are relatively rare. Eventually the fracture was treated with a long gamma3 nail fig. Wardb adepartment of surgery, southmead hospital, north bristol nhs trust, westburyontrym, bristol bs10 5nb, uk. Subtrochanteric fractures of the femur jama surgery. One bursa covers the bony point of the hip bone called the greater trochanter. Trochanteric stabilizing plates the trochanteric stabilizing plate and the lateral buttress plate are modular components that buttress the greater trochanter.
Disruption of the blood supply to the head and neck of the femur can impair fracture healing in these structures figure 2 and figure 3. Systemic corticosteroids alcoholism vasoocclusive diseases. This condition occurs when a bones normal blood supply is disrupted. The full text of this article is available in pdf format. Avascular necrosis of the femoral head following trochanteric. Internal fixation is the treatment of choice for femoral neck fracture in young adults. Pediatric hip fractures and dislocations orthopaedic trauma. Clinical and radiographic controls were performed at 1. Specifically, it is not clear whether trochanteric nonunion or long term trochanteric pain is consequences of such fractures. Fracture of the greater trochanter rarely occurs after thr surgery without osteotomy 3.
Trochanteric hip fractures are almost always treated surgically with internal fixation of the fracture. Avn, fracture nonunion or malunion, or fixation hardware failure. Intertrochanteric fractures are bone breaks between the two trochanters, while. Preventive measures based on antishock trousers have failed to demonstrate efficacy, due to poor compliance, in elderly subjects, fracture entails a serious risk of loss of independence best. Previously, the cause of pain has been attributed solely to trochanteric bursitis. Frequency is increasing with population aging despite the development of treatments for osteoporosis. The patients who sustained inter trochanteric fracture should be monitored for development of avn, and especially if there was an unstable fracture. Subtrochanteric fracture, with a fracture line running from an area within 5 cm distal to the lesser trochanter, is usually also included in the definition. The extent of the break depends on the forces that are involved. A study of management of trochanteric fracture of femur treated with dynamic sliding hip screwplate device vs. Greater trochanteric fractures are a subset of trochanteric fractures. Trochanteric hip fractures ao a2 shs with or without. Key words stem type prosthesis of greater trochanter of the femur, proximal femoral nail antirotation, intertrochanteric femoral, unstable fracture, bone healing. The diagnosis can be done on routine radiographs, but it is difficult to fully define the geographic extent of these injuries.
Mri of seemingly isolated greater trochanteric fractures. Complications of trochanteric fractures musculoskeletal key. The average age of the patients was 80 years and three out of four were female. Review of the patients medical records reveal that she had been evaluated 3 months prior for. This may be an additional aspect of the surgery for any of the above procedures. Inter trochanteric fractures, fracture shaft of femur 1. Most cases were diagnosed within the first two years after fracture. Early prediction of femoral head avascular necrosis following neck. The effect of hip fracture on mortality, hospitalization, and functional status. We present a case of avn of the femoral head following fixation of a stable 2part intertrochanteric fracture in spite of good healing at the hip fracture site. The pain can radiate down the thigh and into the posterior hip, but rarely distal to the knee.
The relationship between femoral neck fracture in adult. Request pdf avascular necrosis of the femoral head following trochanteric fractures in adults. Several types of trochanteric fracture may occur, some of them concurrently. Secondary fai, avn, post traumatic, ddh primary no obvious causedx of exclusion caucasians 36% males more common 1% or less for blacks, chinese, native. A sawbonestm model of a trochanteric fracture was mounted on micrometer screws, and radiographed with different true reference displacements. This allows for additional exposure of the hip joint by lifting the hip abductors off. These fractures are common among older adults and can be related to osteoporosis. This study aims to define the incidence and consequences of this complication. Avascular necrosis of the femoral head at 2 years after. Femoral hip fractures are a common occurrence in the elderly. Trochanteric fractures represent about half of the hip fractures with femoral neck fractures as the other half. The anatomic site of this type of hip fracture is the proximal or upper part of the femur or thigh bone. A trochanteric fracture is a bone break affecting the upper region of the femur or thigh bone, where two bony prominences known as the greater trochanter and lesser trochanter are found. Greater trochanteric bursitis lumbar spine pathology.
The boyd and griffin classification is based on the involvement of subtrochanteric region. We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. These plates are placed over a fourhole sideplate and are used to prevent excessive slide and resulting deformity in. Introduction unstable intertrochanteric femoral fracture, such as comminuted fracture and wedge fracture. Trochanteric bursitis is inflammation swelling of the bursa fluidfilled sac near a joint at the outside lateral point of the hip known as the greater trochanter. It most commonly affects the head of the femur, but can also affect. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. A unique case report of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture and proposed management algorithm. Previously, the cause of pain has been attributed solely to. The additional insertion of a cancellous bone screw provides increased rotational stability. Pediatric proximal femur fracture, pediatric hip fracture, children. The clinical and radiological features appear to be similar to those of idiopathic avascular necrosis of the femoral head. Case report avulsion fracture of the greater trochanter of the femur. Intertrochanteric femur fractures are one of the most serious causes of mortality and morbidity in the elderly.
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