Subtrochantric fracture By Dr sanjeev Subtrochanteric fracture Is

$Subtrochantric fracture By : Dr. sanjeev$

Subtrochantric fracture By : Dr. sanjeev

$Subtrochanteric fracture • Is defined as an area between the lesser trochanter and a$

Subtrochanteric fracture • Is defined as an area between the lesser trochanter and a point 5 cm distal to it. • Mechanism of injury : – Due to direct trauma – Due to RTA or fall – Seen in young individuals

Classification • Fielding`s classification : – Type 1 : # at the level of the lesser trochanter – Type 2 : # 1 inch below the lesser trochanter – Type 3 : # 2 inches below the lesser trochanter

Seinsheimer classification

Clinical features – Pain – Swelling – Shortening – External rotation deformity Radiology : – AP view to study the level and pattern of fracture.

Treatment • Conservative : – In young patient ( modified cast brace) Surgery : – In adults – ORIF is chosen for those # which can be made stable by closed or open reduction

$Cont. . Pattern of fracture – Low transverse # and short oblique # –$

Cont. . Pattern of fracture – Low transverse # and short oblique # – In # above this level without trochanteric extension – In # above this level with trochanteric extension Choice of implant – IM nailing or a interlocking nail – Locking nail or zickel nail – Sliding compression hip screw

Intramedullary nail

Intramedullary hip screw • Combines the features of DHS and intramedullary nail. • Technical and mechanical advantage due to the intramedullary location.

$AO Blade plate in subtrochanteric fracture$

AO Blade plate in subtrochanteric fracture

$Subtrochanteric fracture treated by DCS$

Subtrochanteric fracture treated by DCS

$DHS and Interfragmentary screw in subtrochanteric fracture$

DHS and Interfragmentary screw in subtrochanteric fracture

$Proximal femoral nail This nail is designed for proximal femoral fractures, especially in the$

Proximal femoral nail This nail is designed for proximal femoral fractures, especially in the intertrochanteric region. Nails for proximal fractures must be thicker to withstand the high stress in the intertrochanteric and subtrochanteric regions.

Sliding Screw Fixation in Subtroch Frx

Fig : - Normal Hip X-ray Subtrochanteric Hip Fracture After Fixation with Plate and Screws

Complication – Malunion – Delay union – Nonunion – Shortening – Angular deformity • Factors responsible for slow union : – # through the cortical bone – Large biomechanical stress at the # site results in implant faliure