Postoperative infection, however, is a potentially serious compilation. Video shows the setup and operative technique for intramedullary nailing of a femoral shaft fracture in the lateral position. The purpose of this paper is to examine the recent literature on the epidemiology, classification, initial evaluation, and definitely treatment for these injuries. Ninja nerds, join us in this video where we show the anatomy of the femur through the use of a model. Subtrochanteric femur fractures can occur after highenergy crashes in young patients, or after minimal trauma in the elderly.
Femur subtrochanteric fracture an overview sciencedirect topics. An intertrochanteric fracture is a specific type of hip fracture. Surgical management of subtrochanteric femur fractures in the multiply injured patient poses several challenges due to concomitant injuries and various patient factors. The subtrochanteric region of the femur is an area of great stress concentration and, due to its muscular insertions, is subjected to several deforming forces. The proximal fragment is held in abduction, flexion, and external rotation.
Clinical anatomy lower limb bones, inguinal ligament, hip, knee and ankle joints. Clampassisted reduction of high subtrochanteric fractures of the femur article in the journal of bone and joint surgery 918. The subtrochanteric region is defined as within 5 centimeters distal to the lesser trochanter. It is both the longest and the strongest bone in the human body, extending from the hip to the knee. Management of subtrochanteric proximal femur fractures. Adequate reduction and stable fixation are paramount when treating these fractures to. Family practice notebook 2020, family practice notebook, llc. The strong gluteal and thigh muscles create a classic deformity.
Pdf reduction techniques for difficult subtrochanteric. A trochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and the gluteus minimus hip extensors and. Intramedullary nailing of subtrochanteric femoral fractures in the lateral position october 07, 20 contributors. Subtrochanteric femur fractures statpearls ncbi bookshelf. Intramedullary nailing of a subtrochanteric femur fracture. Subtrochanteric femur fractures in children springerlink.
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. 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. A practical, evidencebased approach to the diagnosis and management of proximal femur fractures. 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. 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. The lesser trochanter projects from the base of the femoral neck on. 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. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. 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. In humans the neck of the femur connects the shaft and head at a. We help you diagnose your proximal femur case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Subtrochanteric hip fractures clinical presentation.
The femur is broken up into different parts including the femoral head, the femoral neck, and the femoral shaft. The medial and posteromedial cortices of the st femur experience the. Subtrochanteric fractures wheeless textbook of orthopaedics. Subtrochanteric femur fractures are an uncommon injury in orthopedics, but when they are encountered they may present difficulties in management. Patients should address specific medical concerns with their physicians. Help us write another book on this subject and reach those readers. 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.
The femur is the only bone located within the human thigh. Consequently, optimum reduction and fixation are essential to avoid complications of implant failure and nonunion. 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. 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. We help you diagnose your proximal femur case and provide detailed descriptions of how to manage this and hundreds of other. This unlabeled quiz of the femur will test your knowledge on how to label the structures of this bone. Choose from 500 different sets of anatomy femur flashcards on quizlet.
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. Pdf subtrochanteric femur fracture treated by intramedullary fixation. One type of femur fracture is termed a subtrochanteric femur fracture. Part i discusses basic principles, including anatomy, biomechanics and surgical approaches to the proximal femur.
Introduction subtrochanteric femur fractures in children are relatively uncommon. According to hhs system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The thigh bone has two bony processes on the upper part the greater and lesser trochanters. Intertrochanteric means between the trochanters, which are bony protrusions on the femur thighbone. These fractures are rare, and there is no clear consensus among authors on the definition of a subtrochanteric femur fracture in children. You will be required to label the fovea capitis, lateral epicondyle, linea aspera, intertrochanteric line, intertrochanteric crest, adductor tubercle, greater. The objective of this study is to investigate indepth the hip fracture anatomy, causes, and consequences. The russelltaylor classification system, noted in their 1992 textbook.
Subtrochanteric femur fractures are difficult to treat due to strong deforming. 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. Subtrochanteric fractures take place in the proximal region of the femur, whose anatomical definition is difficult and controversial. This book is distributed under the terms of the creative commons. During the last 50 years, the treatment of subtrochanteric femur fractures has evolved with improved understanding of both fracture biology and biomechanics. Orthopedics today subtrochanteric fractures of the femur can challenge even the. Pediatric subtrochanteric femur fractures are a challenging subset of fractures to treat, with a relative paucity of literaturebased evidence to support specific algorithmic approaches. Subtrochanteric fractures often are associated with intertrochanteric fractures. Fielding 1 proposed a definition that is still frequently used.
Subtrochanteric typically defined as area from lesser trochanter to 5cm distal. Although access to this page is not restricted, the information found here is intended for use by medical providers. Treatment of comminuted subtrochanteric fractures of the femur. It acts as the site of origin and attachment of many muscles and ligaments, and can be divided into three parts. Treatment of comminuted subtrochanteric fractures of the. Risk factors include osteoporosis, taking many medications, alcohol use, and metastatic cancer. 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. 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.
These will assist the physician to determine the optimal treatment strategy and avoid. However, if a patient is on chronic bisphosphonates for bone health, they may. Learn anatomy femur with free interactive flashcards. Diagram of pathologic anatomy of subtrochanteric fracture. Subtrochanteric fractures occur in the zone about 5 cm below the lesser trochanter of the proximal femur. 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.
Neck of femur fracture subcapital intertrochanteric. The worlds foremost surgeons describe their preferred techniques in stepbystep detail, explain the indications and contraindications. Surgical management of subtrochanteric femur fractures in patients with multiple injuries is associated with several challenges because of concomitant injuries and various patient factors. A subtrochanteric femur fracture could be a serious injury. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The proximal fragment is flexed, abducted, and externally rotated, whereas the femoral shaft is shortened and adducted. 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. Clampassisted reduction of high subtrochanteric fractures. The femur is the only bone in the thigh and the longest bone in the body.
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. 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. Proximal femur fractures an evidencebased approach to.
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