INTERTROCHANTERIC

FEMUR FRACTURE
ELMIRA APRILIANI
20100310095

INTRODUCTION

Netter. FN. The Ciba Collection of Medical Illustration. Vol 8. Ciba Pharmaceutical Co; 1987: Part I: 85-103
Netter. FN. The Ciba Collection of Medical Illustration. Vol 8. Ciba Pharmaceutical Co; 1987: Part III: 92

ANATOMY

http://emedicine.medscape.com/article/1247210-overview#a04

Os Femur. Anterior view.

R.Putz & R.Pabst, Atlas Anatomi Manusia, Sobotta, Jilid II

Os Femur. Posterior view.

Os Femur. Medial view.

R.Putz & R.Pabst, Atlas Anatomi Manusia, Sobotta, Jilid II

EPIDEMIOLOGY

Bojan AJ, Beimel C, Speitling A, et al. 3066 consecutive Gamma Nails. 12 years experience at a single centre. BMC Musculoskelet
Disord. 2010;11:133.

ETIOLOGY

Cauley JA, Lui LY, Genant HK, Salamone L, Browner W, Fink HA, et al. Risk factors for severity and type of the hip fracture. J Bone
Miner Res. May 2009;24(5):943-55.

CLASSIFICATION

http://emedicine.medscape.com/article/1247210-overview#a04

CLASSIFICATION

http://emedicine.medscape.com/article/1247210-overview#a04

CLASSIFICATION

http://emedicine.medscape.com/article/1247210-overview#a04

PHYSICAL EXAM

http://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

IMAGING

http://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

TREATMENT

http://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

TREATMENT

http://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

OPERATIVE

http://www.orthobullets.com/trauma/1038/intertrochanteric-fractures

COMPLICATION

http://emedicine.medscape.com/article/1247210-overview#a04

PROGNOSIS AND OUTCOME

Barton TM, Gleeson R, Topliss C, et al. A comparison of the long gamma nail with the sliding hip screw for the treatment of AO/OTA
31-A2 fractures of the proximal part of the femur: a prospective randomized trial. J Bone Joint Surg Am. Apr 2010;92 (4): 792-8.

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD,

and Daniel S. Horwitz, MD

WHAT MAKES AN INTERTROCHANTERIC

FRACTURE UNSTABLE IN 2015? DOES THE
LATERAL WALL PLAY A ROLE IN THE
DECISION MATRIX?

INTRODUCTION

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

POSTEROMEDIAL COMPONENT

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

POSTEROMEDIAL COMPONENT

Preoperative (A and B)
Intraoperative (C and D)
Postoperative (E and F)
Images of
an unstable IT fracture
with posteromedial
comminution.
Note the healing with
posterior sag
seen in the
postoperative images,
despite obtaining
excellent alignment
intraoperatively.
Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

REVERSE OBLIQUE FRACTURE

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

REVERSE OBLIQUE FRACTURE

Preoperative (A and B)
postoperative (C and D)
images of a reverse oblique IT
fracture.

Note the fracture line is parallel

to the
head fixation device, and hence,
SHS is not recommended
in the presence of this fracture
pattern.

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

IT FRACTURE WITH
SUBTROCHANTERIC EXTENSION

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

IT FRACTURE WITH
SUBTROCHANTERIC EXTENSION

Preoperative (A and B)
Postoperative (C and D)
images showing IT fracture
with subtrochanteric extension.

In this case, the

fracture was rotationally
unstable, and hence,
derotation device was placed.

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

LATERAL BLOW-OUT

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

LATERAL BLOW-OUT
An IT fracture in an extremely
osteoporotic
bone (A and B) fixed with an SHS
(C).
Note the lateral wall blow-out in
the immediate
postoperative image (D) with
medialization of the
distal fragment.

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

REVERSE OBLIQUE VARIANT

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

REVERSE OBLIQUE VARIANT

Preoperative (A and B)
Postoperative (C and D)
images of the reverse oblique
variant pattern
Note the typical IT fracture pattern
appearance in the anteroposterior
view (A) and
the obliquity (B and D) in the
lateral view.
In the presence of such obliquity,
perhaps long nail is
a better choice than a short nail.

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

OSTEOPOROSIS

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

ROTATIONALLY UNSTABLE

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

CONCLUSION

Akhil A. Tawari, MS, Harish Kempegowda, MS, Michael Suk, MD, and Daniel S. Horwitz, MD. What makes an intertrochanteric
fracture unstable in 2015? Does the lateral wall play a role in the decision matrix?

Thank you