Adequate reduction and stable fixation are paramount when treating these fractures to. The proximal fragment is held in abduction, flexion, and external rotation. A practical, evidencebased approach to the diagnosis and management of proximal femur fractures. According to hhs system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The head forms a ballandsocket joint with the hip at the acetabulum, being held in place by a ligament within the socket and by strong surrounding ligaments. Neck of femur nof fractures can occur anywhere from the subcapital region of the femoral head to 5cm distal to the lesser trochanter fig. A hip fracture is a break that occurs in the upper part of the femur thigh bone. It acts as the site of origin and attachment of many muscles and ligaments, and can be divided into three parts. The medial and posteromedial cortices of the st femur experience the.
Fielding 1 proposed a definition that is still frequently used. Subtrochanteric femur fractures can occur after highenergy crashes in young patients, or after minimal trauma in the elderly. Intramedullary nailing of subtrochanteric femoral fractures in the lateral position october 07, 20 contributors. At the subtrochanteric level, most fractures are managed with a long intramedullary nail together with a large lag screw or they are managed with screws that capture the neck and head of the femur or the area immediately underneath it, if it has remained intact. Neck of femur fracture subcapital intertrochanteric. The subtrochanteric region has been defined in various ways, but most commonly the area between the inferior border of the lesser trochanter and the isthmus of the femoral shaft or the inferior border of the lesser trochanter to the junction of proximal and middle one third of the femur is taken as subtrochanteric region stephen h. Diagram of pathologic anatomy of subtrochanteric fracture. Part i discusses basic principles, including anatomy, biomechanics and surgical approaches to the proximal femur. Consequently, optimum reduction and fixation are essential to avoid complications of implant failure and nonunion. Discusses femoral anatomy and biomechanics, surgical approaches, femoral head and neck fractures, intertrochanteric and subtrochanteric fractures, nonunions and femoral shaft fractures, as well as quality and patient safety. Subtrochanteric fractures wheeless textbook of orthopaedics. Clinical anatomy lower limb bones, inguinal ligament, hip, knee and ankle joints. The blood supply to the bone of the subtrochanteric region is not as good as the blood supply to the bone of the intertrochanteric region, and thus subtrochanteric fracture heals more slowly 68. One type of femur fracture is termed a subtrochanteric femur fracture.
Completely updated for its third edition, fractures, the acclaimed master techniques in orthopaedic surgery volume presents the most advanced, successful surgical techniques for fractures of the upper extremity, lower extremity, pelvis, and acetabulum. Video shows the setup and operative technique for intramedullary nailing of a femoral shaft fracture in the lateral position. Subtrochanteric fractures generally have a good prognosis due to the good supply of blood and adequate collateral circulation to this region of the femur with a low incidence of avascular necrosis and nonunion. The strong gluteal and thigh muscles create a classic deformity. Subtrochanteric typically defined as area from lesser trochanter to 5cm distal. However, if a patient is on chronic bisphosphonates for bone health, they may.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. It is both the longest and the strongest bone in the human body, extending from the hip to the knee. Introduction subtrochanteric femur fractures in children are relatively uncommon. The femur is the only bone located within the human thigh. The lesser trochanter projects from the base of the femoral neck on.
Subtrochanteric fractures often are associated with intertrochanteric fractures. Ninja nerds, join us in this video where we show the anatomy of the femur through the use of a model. Subtrochanteric femur fractures are difficult to treat due to strong deforming forces at the fracture site, tenuous blood supply, and the immense loadbearing forces exerted through the peritrochanteric region. Pdf reduction techniques for difficult subtrochanteric. This unlabeled quiz of the femur will test your knowledge on how to label the structures of this bone. Subtrochanteric fractures occur in the zone about 5 cm below the lesser trochanter of the proximal femur. An intertrochanteric fracture is a specific type of hip fracture. Proximal femur fractures an evidencebased approach to. Management of subtrochanteric proximal femur fractures. Anatomy occur in the region between the greater and lesser trochanters of the proximal femur, occasionally extending into the subtrochanteric region since they occur in cancellous bone with abundant blood supply no problems of nonunion and osteonecrosis 8. We help you diagnose your proximal femur case and provide detailed descriptions of how to manage this and hundreds of other.
Anatomy the subtrochanteric region of the femur, arbitrarily designated as the region between the lesser trochanter and a point 5 cm distal, consists primarily of cortical bone. Subtrochanteric femur fractures statpearls ncbi bookshelf. Family practice notebook 2020, family practice notebook, llc. The femur is broken up into different parts including the femoral head, the femoral neck, and the femoral shaft. In humans the neck of the femur connects the shaft and head at a.
The russelltaylor classification system, noted in their 1992 textbook. Subtrochanteric femur fractures are an uncommon injury in orthopedics, but when they are encountered they may present difficulties in management. Choose from 500 different sets of anatomy femur flashcards on quizlet. Femur subtrochanteric fracture an overview sciencedirect topics. Orthopedics today subtrochanteric fractures of the femur can challenge even the. Surgical management of subtrochanteric femur fractures in patients with multiple injuries is associated with several challenges because of concomitant injuries and various patient factors. The classic deformities are flexion provoked by the iliopsoas, abduction by the gluteus medius, and external rotation by the external rotators of the proximal fragment of the femur. We help you diagnose your proximal femur case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Pdf subtrochanteric femur fracture treated by intramedullary fixation. The femur is the only bone in the thigh and the longest bone in the body. During the last 50 years, the treatment of subtrochanteric femur fractures has evolved with improved understanding of both fracture biology and biomechanics. The worlds foremost surgeons describe their preferred techniques in stepbystep detail, explain the indications and contraindications. The above image is a 3d reconstruction from the raw data of a ct of the abdomen and pelvis, such that the patient did not have to undergo additional scanning and radiation exposure to get this image of the femur. You will be required to label the fovea capitis, lateral epicondyle, linea aspera, intertrochanteric line, intertrochanteric crest, adductor tubercle, greater.
Detailed chapters focusing on individual fracture locations and types comprise part ii, such as femoral head and neck fractures, intertrochanteric and subtrochanteric fractures, and nonunions. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. These will assist the physician to determine the optimal treatment strategy and avoid. Management of subtrochanteric femur fractures with the use of an intramedullary nail and the patient in the lateral decubitus position on a regular radiolucent surgical table with manual traction may be.
Clampassisted reduction of high subtrochanteric fractures of the femur article in the journal of bone and joint surgery 918. This book is distributed under the terms of the creative commons. The objective of this study is to investigate indepth the hip fracture anatomy, causes, and consequences. Postoperative infection, however, is a potentially serious compilation. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Surgical management of subtrochanteric femur fractures in the multiply injured patient poses several challenges due to concomitant injuries and various patient factors. These fractures are rare, and there is no clear consensus among authors on the definition of a subtrochanteric femur fracture in children. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Treatment of comminuted subtrochanteric fractures of the. The proximal fragment is flexed, abducted, and externally rotated, whereas the femoral shaft is shortened and adducted. Treatment of these fractures with an intramedullary nail in the lateral decubitus position on a regular radiolucent table with manual traction may be advantageous, however can be technically challenging. Intramedullary nailing of a subtrochanteric femur fracture. Subtrochanteric femur fractures in children springerlink.
A trochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and the gluteus minimus hip extensors and. A subtrochanteric femur fracture could be a serious injury. Pediatric subtrochanteric femur fractures are a challenging subset of fractures to treat, with a relative paucity of literaturebased evidence to support specific algorithmic approaches. The femur neck femoral neck or neck of the femur is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward. Previously, nonsurgical treatment of these fractures was associated not only with significant shortening and malrotation but also with the morbidity and mortality of prolonged immobiliza.
Although access to this page is not restricted, the information found here is intended for use by medical providers. Consequently, optimum reduction and fixation are essential to avoid complications of. Help us write another book on this subject and reach those readers. Subtrochanteric femur fractures are difficult to treat due to strong deforming. Subtrochanteric definition, either of two knobs at the top of the femur, the greater on the outside and the lesser on the inside, serving for the attachment of muscles between the thigh and pelvis. Subtrochanteric fractures take place in the proximal region of the femur, whose anatomical definition is difficult and controversial. The thigh bone has two bony processes on the upper part the greater and lesser trochanters. Subtrochanteric fractures of the femur occur in an area with high mechanical stresses both axial and torsional. The purpose of this paper is to examine the recent literature on the epidemiology, classification, initial evaluation, and definitely treatment for these injuries. Subtrochanteric hip fractures clinical presentation. The subtrochanteric region is defined as within 5 centimeters distal to the lesser trochanter. Patients should address specific medical concerns with their physicians.
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