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Subtrochantric fracture

Subtrochantric fracture. By : Dr. sanjeev. Subtrochanteric fracture. Is defined as an area between the lesser trochanter and a point 5 cm distal to it . Mechanism of injury : - Due to direct trauma Due to RTA or fall Seen in young individuals. Classification.

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Subtrochantric fracture

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  1. Subtrochantric fracture By : Dr. sanjeev

  2. Subtrochanteric fracture • Is defined as an area between the lesser trochanter and a point 5 cm distal to it . • Mechanism of injury : - • Due to direct trauma • Due to RTA or fall • Seen in young individuals

  3. Classification • Fielding`s classification : - • Type 1 : # at the level of the lesser trochanter • Type 2 : # 1 inch below the lesser trochanter • Type 3 : # 2 inches below the lesser trochanter

  4. Seinsheimer classification

  5. Clinical features • Pain • Swelling • Shortening • External rotation deformity Radiology : - • AP view to study the level and pattern of fracture.

  6. Treatment • Conservative : - • In young patient ( modified cast brace) Surgery : - • In adults • ORIF is chosen for those # which can be made stable by closed or open reduction

  7. Pattern of fracture Low transverse # and short oblique # In # above this level without trochanteric extension In # above this level with trochanteric extension Choice of implant IM nailing or a interlocking nail Locking nail or zickel nail Sliding compression hip screw Cont..

  8. Intramedullary nail

  9. Intramedullary hip screw Combines the features of DHS and intramedullary nail. Technical and mechanical advantage due to the intramedullary location.

  10. AO Blade plate in subtrochanteric fracture

  11. Subtrochanteric fracture treated by DCS

  12. DHS and Interfragmentary screw in subtrochanteric fracture

  13. Proximal femoral nail This nail is designed for proximal femoral fractures, especially in the intertrochanteric region.  Nails for proximal fractures must be thicker to withstand the high stress  in the intertrochanteric and subtrochanteric regions.

  14. Sliding Screw Fixation in Subtroch Frx

  15. Fig : - Subtrochanteric Hip Fracture Normal Hip X-ray After Fixation with Plate and Screws

  16. Complication • Malunion • Delay union • Nonunion • Shortening • Angular deformity • Factors responsible for slow union : - • # through the cortical bone • Large biomechanical stress at the # site results in implant faliure

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