This gives rise to the conjecture that poor soft tissue padding, poor reflexes and weakness are actually what causes the fracture. Although the kinetic energy of such a fall is far more than is needed to break the bone, most falls do not lead to fracture. Intertrochanteric fractures are often seen in frail older people after low energy falls (ie, from a standing height). The key criterion of any robust classification is whether the fracture can be considered stable or unstable. Even if there is no comminution and even if the fracture line does not reach the subtrochanteric region, this fracture is unstable and prone to displacement with conventional sliding screws, as the fracture line is parallel to the course of the sliding screw and displaces as the screw slides. In reverse obliquity fractures, the fracture line courses laterally as it extends from proximal to distal, running perpendicular to the intertrochanteric line. IV displaced with lesser trochanteric (posteromedial) andĪ special category is the "reverse obliquity fracture". III displaced with greater trochanteric (posterolateral) comminution Intertrochanteric fractures can be classified (Evans, 1949) as the following Types: The adductors attach to the shaft below the intertrochanteric region, possibly displacing the shaft medial relative to the proximal fragment(s). The abductors and short external rotators attach to the greater trochanter the iliopsoas to the lesser. AnatomyĪs the name implies, an intertrochanteric fracture is one where the fracture line lies between the greater and lesser trochanters. Unlike a subtrochanteric fracture, it can be (but not always is) inherently stable. Unlike a femoral neck fracture, the intertrochanteric region has good blood supply to cancellous bone, and thus has good healing potential. See Hip fractures for a general discussion. Hip fractures can be divided into two groups: intra-capsular femoral neck fractures (further localized as subcapital, transcervical or basicervical) and extra-capsular peri-trochanteric fractures, namely the intertrochanteric and subtrochanteric fractures.
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