Trochanteric fracture

1. Trochanteric fracture Gopisankar.M.G. 2008 MBBS

2. Occurs along a line between greater trochanter and lesser trochanter with variable comminution Totally extracapsular Four times more common than intracapsular

3. Age  seen in elderly patients 10 – 12 years older than intracapsular # neck of femur Sex  f:m = 2.8 : 1

4. Clinical features Pain in the hip Marked shortening of the lower limb Complete external rotation deformity Swelling Echymosis Tenderness over the greater trochanter

5. X ray

6. Treatment Conservative  10 % mortality Surgical

7. Conservative Indication Poor medical and surgical risk patients Terminally ill patients Very old patients Methods Simple support with pillows Buck’s traction Plaster spica Skeletal traction through distal femur or tibia for 10 – 12 weeks

8. Buck’s traction

9. Hip spica

10. Traction using Bohler Braun frame

11. Surgica l 10 fold rise in mortality if surgery is delayed for > 48 hrs. Goal is to fix a stably reduced fracture internally

12. Methods of reduction Closed Reduction  traction , slight abduction and external rotation if cannot reduce  open reduction done Open Reduction  indications Failed closed reduction Large spike on proximal fragment with lesser trochanter intact Reverse oblique fracture Reduction Anatomically /non anatomically

13. Implants Dynamic Hip screw (DHS) Proximal Femoral nails (PFN)

14. Dynamic Hip Screws

15. Proximal Femoral Nails

16. Complications Malunion Coxa vara Traumatic Osteoarthritis