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Trochanteric fracture

Trochanteric fracture. Trochanteric fracture . More common in female Mechanism of injury : - Direct trauma : RTA , fall Indirect trauma : muscle pull Clinical features : - Pain Marked shortening of the lower limb Complete external rotation deformity Swelling Ecchymosis

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Trochanteric fracture

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  1. Trochanteric fracture

  2. Trochanteric fracture • More common in female Mechanism of injury : - • Direct trauma : RTA , fall • Indirect trauma : muscle pull Clinical features : - • Pain • Marked shortening of the lower limb • Complete external rotation deformity • Swelling • Ecchymosis • Tenderness over the greater trochanter

  3. Radiology : - • AP view in internal rotation • Lateral view ( # pattern ) Treatment : - Conservative : - Indications: • Poor medical and surgical risk patients • Terminally ill patients • Very old patients Methods : - • Simple support with pillows • Buck`s traction • Plaster spica • Skeletal traction through distal femur or tibia for 10 to 12 weeks

  4. Dynamic hip screw- DHS Most commonly used device for both stable and unstable fracture patterns. Plate angle is variable 130 to 150 degrees. Has to be positioned centrally in the femoral head. Use of radiological views to know the exact position.

  5. Trochanteric fracture fixated with a proximal femoral intramedullary nail.

  6. Buck's traction A longitudinal skintraction applied to extremity in one direction with a single pulley, and keeping the leg in extended position without hip flexion. It is used to treat fractures, to realign broken bones, to correct contractures or deformities, and for kneeimmobilization.

  7. Hip spica plaster

  8. 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.

  9. Dynamic hip screw transfixing an trochanteric fracture

  10. Skeletal traction

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

  12. Surgical complications • Loss of fixation, might be due to- • Improper placing. • Improper reduction. • Nonunion • Less than 2%. • Usually in unstable fracture.

  13. Malunion • Results in coxa vara ( decreased femoral neck -shaft angle) . • shortening of limb. • Leads to limping. • If minor shortening -shoe raise is advised. • In young people with severe deformity osteotomy and internal fixation is required. • Traumatic Osteoarthritis • Avascular necrosis ( rare )

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