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




When to expect healing in this fracture ?
Around four months.
There is always a race between union and implant failure due to fatigue.
 Non-union chance is 5-10 %.


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