NRS-numeric rating scale :4 -6 " moderate pain

decrease in mineralization

for dicussion, we will discuss this case theoritically and patient's situation

snells clinical anatomy

The strong muscles of the thigh including the rectus femoris, the adductor
muscles, and the hamstring muscles, pull the distal fragment upward, so that the
leg is shortened (as measured from the anterior superior iliac spine to the adductor
tubercle or medial malleolus). The gluteus maximus, the piriformis, the obturator
internus, the gemelli, and the quadratus femoris rotate the distal fragment laterally,
as seen by the toes pointing laterally.Trochanteric fractures commonly occur in the
young and middle aged as a result of direct trauma. The fracture line is
extracapsular, and both fragments have a profuse blood supply. If the bone
fragments are not impacted, the pull of the strong muscles will produce shortening
and lateral rotation of the leg, as previously explained.
external capsule : located outer of hip capsule which is....

LFC ; LATERAL FEMORAL CIRCUMFLEX ARTERY

because of there is abundant blood supply in intertrochateric region, so non union
and osteonecrosis are not major problems

why women??? -post menaopausal metabolic change, less of estrogen, make

bone mass decrease Men, still has testosterone support.
parkinsons disease- decrease dopamine in basal ganglia, pt got unstable gait,
freezing gait (festinating gait),flexed gait, her feet felt glued to the ground
90% intertrochanteric fr. cause by fall, pathologic fracture

why shortening???
wnhy rotate externally??
why varus??
why pain??

stable unstable evan

OTA yg
from rockwood

These fractures are divided into three groups, and each group is further divided
into subgroups based on obliquity of the fracture line and degree of comminution.
Group 1 fractures are simple (two-part) fractures, with the typical oblique fracture
line extending from the greater trochanter to the medial cortex. The lateral cortex
of the greater trochanter remains intact. Group 2 fractures are comminuted with a
posteromedial fragment. The lateral cortex of the greater trochanter, however,
remains intact. Fractures in this group are generally unstable, depending on the
size of the medial fragment. Group 3 fractures are those in which the fracture line
extends across both the medial and lateral cortices. This group includes the
reverse obliquity pattern.

rarely, use an non operative treatment

why operation?? -to compress (body think this is normal process of remodellingcomplete union)
as load shielding
why not hemiartroplasty

thromboembolism - bed rest

malunion-delay treatment