Subtrochanteric Fractures
Subtrochanteric Fractures
Common in elderly people.
Causes - simple fall from standing.
Fragility or Pathological fractures
High energy fractures
Russel Taylor Classification
1. Intact Pyriformis fossa
A. Lesser trochanter intact
B. Lesser trochanter detached
2. Pyriformis fossa involved
A. Intact posteromedial buttress
B. Communition of posteromedial buttress
Seinsheimer Classification - offers guideline for management and prognosis.More distal the primary fracture line is , the higher the incidence of complications.
https://www.slideserve.com/mairi/subtrochanteric-fractures
Management in Preoperative phase
Assess medical condition, Past Co-illnesses, r/o metastasis,
Exclude other injuries
NV status
Analgesia
Immobilize in Thomas Splint
X-ray - Whole Femur
Routine blood inv.
Arrange Blood
Fixation of this fracture
No any gold standard method.
Historically , plating used to be done. 95 degrees condylar screw plate is a good recent option.It gives a good proximal and distal control. It permits at least two cortical screws in proximal fragment into proximal fragement.
Recent option - Nailing
All methods have sizable failure rate.
Massive biomechanical loads transmitted through this area.
Deforming forces
If lesser trochanter attached to proximal fragment, Psoas tendon causes flexion and abduction of proximal fragment.
Medial group of adductor muscles pull the distal fragment medially.
https://www.researchgate.net/figure/A-B-C-A- comminuted-subtrochanteric-fracture-was- treated-by-MIPO-minimally- invasive_fig1_287961100
Around four months.
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