Intertrochanteric

Clinical features

• Hip pain and swelling

• Shortened and externally rotated leg

• Significant ecchymosis

• Often associated with other injuries (e.g. other extremity fractures)

Diagnostics

• X-ray (AP view with maximal internal rotation and lateral view): proximal femur fracture between the greater and lesser trochanters

• MRI if a pathological fracture is suspected

Treatment

• Nonsurgical approach for high risk patients

• Surgery

  • Dynamic hip screw (DHS) for stable fractures

  • Intramedullary nail (Gamma nail) for stable or unstable fractures, fractures extending into the subtrochanteric region, or reverse oblique fractures

  • Arthroplasty may be considered for comminuted fractures, pathological fractures, or if other surgical modalities fail.