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Intertrochanteric, Subtrochanteric & Femur Shaft Fracures

Intertrochanteric, Subtrochanteric & Femur Shaft Fracures. Dr. Wahby Ghalib CABMS FJMC MRCS. Intertrochanteric Fractures. Predisposition. Osteoporosis. Mechanism. Fall on greater trochanter twisting. CF. Elderly Can not stand Leg short & externally rotated. XR.

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Intertrochanteric, Subtrochanteric & Femur Shaft Fracures

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  1. Intertrochanteric, Subtrochanteric &Femur Shaft Fracures Dr. Wahby Ghalib CABMS FJMC MRCS

  2. Intertrochanteric Fractures

  3. Predisposition • Osteoporosis

  4. Mechanism • Fall on greater trochanter • twisting

  5. CF • Elderly • Can not stand • Leg short & externally rotated

  6. XR • # runs from greater to lesser trochanter

  7. Classification (Evans) • Stable • Unstable

  8. Unstable # • > 2 pieces • Reverse oblique • Subtrochanteric extension

  9. Rx • Early IF

  10. Complications of prolonged immobilization • DVT • PE • Bed sores • Pneumonia • UTI • hypercalcaemia

  11. Mortality rate of hip # • 30 % die in the 1st year

  12. Cx • AVN & NU are not common • Malunion

  13. Subtrochanteric #

  14. Within 5cm from lesser trochanter

  15. Young : hi energy trauma • Elderly : osteoporosis

  16. CF • Can not stand • Leg short & externally rotated

  17. Rx • ORIF

  18. Femur Shaft #

  19. Femur is the longest largest & strongest bone

  20. It is # of young : RTA FFH • Elderly : pathologic until proved otherwise • Child : may be battered baby

  21. CF • Blood loss : 1-2 L • Look for other #s • 10 % : there is FN #

  22. Rx • Early stabilization to prevent systemic cx : ARDS MOF PE fat embolism

  23. Rx • <6yr  nonoperative • 6-10yr  controversial • >10yr  operative

  24. Nonoperative Rx • Traction 2-4 w  hip spica 6-12 w

  25. Operative Rx • Plate & screws • IMN • EF in open #

  26. Thank You

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