What is Intertrochanteric Fracture?
A fracture is defined as a break in the continuity of the bone when a force against your body is too strong for the bone to bear. Intertrochanteric fracture is a break in the proximal femur, between the greater trochanter and the lesser trochanter. It is a type of hip fracture that occurs 3 to 4 inches from the hip joint.
Intertrochanteric fractures account for about thirty-eight to fifty percent of all hip fractures and are very commonly seen in the elderly. Women are more prone to these fractures than men.
Intertrochanteric fractures are extracapsular in nature, meaning the fracture occurs outside the fibrous capsule of the hip joint, and hence does not interrupt the blood supply to the bone, thereby making it easier to treat or repair.
Anatomy of the Trochanter
The trochanter is a bony prominence (projection or protuberance) of the femur near its joint with the hip bone. It serves as a site for muscle attachment. Anatomically, your femur has two trochanters:
- Greater trochanter – The outside ball at the top of the femur. This is also called the major or outer trochanter
- Lesser trochanter – The inside knob at the top of the femur
These trochanters together act as a point where the hip and thigh muscles attach.
Causes of Intertrochanteric Fractures
Intertrochanteric fractures most often occur as a result of a low energy fall in the elderly and a high-energy trauma such as a fall from a height or motor vehicle collision in the young. The elderly are more likely to experience a fracture as they are at an increased risk of falling. In some cases, individuals who have weak bones such as with osteoporosis and other bone diseases can have a fracture from simply standing or walking. People with active lifestyles, high-intensity sports, and athletes are also prone to intertrochanteric fractures.
Signs and Symptoms of Intertrochanteric Fractures
The signs and symptoms of intertrochanteric fractures include:
- Severe pain in the hip or groin
- Swelling and bruising around the hip
- Inability to bear weight on the injured leg
- Unable to stand up or move after a fall
- Pain and stiffness in the injured leg
- Affected leg is externally rotated and shortened
Risk Factors for Intertrochanteric Fractures
You are more likely to have an intertrochanteric fracture if you:
- Have a history of femoral fracture
- Have osteoporosis (a disease causing weak bones) or other bone disorders
- Have problems with gait or balance
- Have a history of falls
- Are female
- Are older than 60 years
- Have low muscle mass and low bone density
Diagnosis of Intertrochanteric Fracture
To diagnose an intertrochanteric fracture, your doctor will review your symptoms and medical history and conduct a thorough physical examination to look for signs of swelling, bruises, or any other abnormalities in the proximal femur. If your physician suspects a fracture, he or she will order the following imaging studies to confirm the diagnosis and obtain further information on the type and severity of the fracture.
- X-rays: This study uses high electromagnetic energy beams to produce images of the femur and help detect whether the femur is intact or broken and the type of fracture and its location. However, X-rays may not be able to detect about 10 percent of fractures.
- CT scan: This scan uses special X-rays that produce images of the cross-section of the femur with clear images of any damage present that is not visible in an X-ray. CT scans can detect about 8 percent of all hip fractures that are missed by an X-ray.
- MRI Scan: This study uses large magnetic fields and radio waves to produce images of the fracture and damaged soft tissues not visible in an X-ray or CT scan. About 2 percent of all hip fractures that go undetected on CT scans and X-rays, can be seen on an MRI scan.
Treatment for Intertrochanteric Fracture
Most intertrochanteric fractures require surgical treatment within a couple of days of injury. Only a very few cases that involve nondisplaced fractures in healthy individuals can be treated without surgery with non-weight bearing of the injured area with early out of bed to chair.
Surgical treatment may include:
- Open Reduction and Internal Fixation (ORIF): This surgical method is employed for stable intertrochanteric fractures and involves an open incision (long surgical cut) to access the broken bones and reposition or realign them into their normal position. This is followed by internal fixation utilizing a fixation device such as a sliding hip screw coupled to a side metal plate that is screwed to the femoral shaft to stabilize and hold the broken bones in place together while they heal.
- Intramedullary Nailing: This surgical method is employed for unstable intertrochanteric fractures and involves placing an intramedullary nail into the central canal of the femur passing across the fracture site. Both ends of the intramedullary nail are secured to the bone with intramedullary hip screws to keep the bones and nail in proper position while the fracture heals.
- Percutaneous External Fixation: During this procedure, screws or metal pins are placed into the bone below and above the site of the fracture by accessing the treatment area with incisions. The screws and pins are secured to a supportive device such as a bar or a frame outside the skin which holds the bones in the correct position while they heal.
- Hip arthroplasty: This is commonly known as hip replacement surgery and is indicated for conditions such as severe unstable intertrochanteric fractures, failed fracture fixation surgery, or osteoporotic bone that is unlikely to hold internal fixation. During hip arthroplasty, a section or all of the hip joint is replaced with artificial components. In partial hip arthroplasty, your surgeon replaces only the broken upper portion of the femur. In total hip arthroplasty, both the broken upper part and the hip socket are replaced.
After the surgery, your doctor will recommend physical therapy to strengthen the thighbone and surrounding muscles to help ensure return to optimum function as quickly as possible.