eMedicine Specialties > Orthopedic Surgery > Hip

Intertrochanteric Hip Fractures: Follow-up

Author: Richard S Goodman, MD, JD, FAAOS, Chair, Department of Surgery, SABA University Medical School; Consulting Staff, Department of Orthopedics, Long Island Jewish/North Shore University Hospital
Contributor Information and Disclosures

Updated: Nov 3, 2009

Outcome and Prognosis

A stable and acceptably fixed intertrochanteric fracture is expected to heal. The activity level of elderly patients usually drops 1 level after recovery from this injury. The mortality rate is 20-30% during the first year after fracture for these patients.

Future and Controversies

The future of intertrochanteric fracture repair focuses, in part, on the prevention of the fracture from antiosteoporosis treatments, including medications and health programs. Another focus includes fixation devices that require smaller incisions and are more forgiving, with retention of the fixation, regardless of whether the fracture is ideally reduced or has an element of instability. Finally, the goal is to eliminate or substantially decrease the mortality and morbidity of postoperative DVT and pulmonary emboli by developing a better understanding of the clotting mechanism and the genetic, metabolic, serologic, and hormonal factors that affect the likelihood of developing pulmonary emboli.

The current controversy regarding pulmonary emboli prevention is over the antiembolism treatments available, with a conflict between anticoagulants (eg, aspirin, heparin, warfarin) and mechanical protocols (eg, antiembolism stockings) to prevent emboli.

 


More on Intertrochanteric Hip Fractures

Overview: Intertrochanteric Hip Fractures
Workup: Intertrochanteric Hip Fractures
Treatment: Intertrochanteric Hip Fractures
Follow-up: Intertrochanteric Hip Fractures
Multimedia: Intertrochanteric Hip Fractures
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Netter FN. The Ciba Collection of Medical Illustrations. Vol 8. Ciba Pharmaceutical Co;. 1987:Part I:85-103.

  2. Netter FN. The Ciba Collection of Medical Illustrations. Vol 8. Ciba Pharmaceutical Co;. 1987:Part III:92.

  3. Rang M. Story of Orthopaedics. Philadelphia, Pa: WB Saunders;. 2000:373-395.

  4. Kaplan K, Miyamoto R, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. II: intertrochanteric fractures. J Am Acad Orthop Surg. Nov 2008;16(11):665-73. [Medline].

  5. Anglen JO, Baumgaertner MR, Smith WR, Tornetta Iii P, Ziran BH. Technical tips in fracture care: fractures of the hip. Instr Course Lect. 2008;57:17-24. [Medline].

  6. Bhandari M, Schemitsch E, Jönsson A, Zlowodzki M, Haidukewych GJ. Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis. J Orthop Trauma. Jul 2009;23(6):460-4. [Medline].

  7. Sidhu AS, Singh AP, Singh AP, Singh S. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients. Int Orthop. Jun 11 2009;[Medline].

  8. Bick EM. Fractures of the neck of the thigh bone. In: Classics of Orthopaedics. Philadelphia, Pa: Lippincott Williams; & Wilkins. 1976:434-436.

  9. Cooper A. A Treatise on Dislocations and Fractures of the Joints. London, England: Longman, Hurst, Rees, Orme and Brown; 1822.

  10. Bick EM. Source Book of Orthopaedics. Baltimore, Md: The Williams and Wilkins Company;. 1948:298-306.

  11. Cordasco P. Evolution of treatment of fracture of the neck of the femur. Arch Surg. 1938:37. 871.

  12. Hamilton FH. Practical Treatise on Fractures and Dislocations. 1866: 390-393.

  13. Cauley JA, Lui LY, Genant HK, Salamone L, Browner W, Fink HA, et al. Risk factors for severity and type of the hip fracture. J Bone Miner Res. May 2009;24(5):943-55. [Medline].

  14. Lichtblau S. The unstable intertrochanteric hip fracture. Orthopedics. Aug 2008;31(8):792-7. [Medline].

  15. Anglen JO, Weinstein JN. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg Am. Apr 2008;90(4):700-7. [Medline].

  16. Cotton FJ. Hip fractures and their treatment. Boston Med Surg J 1996; 170: 718.

  17. Crenshaw AH. Campbell's Operative Orthopedics. Vol 2. 8th ed. Philadelphia, Pa: Mosby Inc;. 1991:895-915.

  18. Epps CH Jr. Complications in Orthopaedic Surgery. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins;. 1994:459-470.

  19. Evarts CM. Surgery of the Musculoskeletal System. Vol 3. 2nd ed. New York, NY: Churchill Livingstone;. 1990:2613-2641.

  20. Foy MA, Fagg PS. Medicolegal Reporting in Orthopaedic Trauma. 3rd ed. New York, NY: Churchill Livingstone Inc;. 2001:235-261.

  21. Gossling HR, Pillsbury SL. Complications of Fracture Management. Philadelphia, Pa: Lippincott Williams & Wilkins;. 1984:399-419.

  22. Krames. After a Hip Fracture. San Bruno, Calif: The Stay Well Co;. 2004.

  23. Rockwood CA, Green DP, Bucholz RW. Fractures. Vol 2. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins. 1991:1538-1560.

  24. Skinner HB. Current Diagnosis and Treatment in Orthopedics. New York, NY: Appleton & Lange;. 1995:109-120.

  25. Sledge CB. Master Techniques in Orthopaedic Surgery: The Hip. Philadelphia, Pa: Lippincott-Raven;. 1998:109-139.

  26. Watson-Jones R. Fractures and Joint Injuries. Vol 2. New York, NY: Churchill Livingstone Inc;. 1960:707-711.

  27. Zuckerman JD. Comprehensive Care of Orthopaedic Injuries in the Elderly. Philadelphia, Pa: Lippincott Williams & Wilkins;. 1990:23-113.

[ CLOSE WINDOW ]

Keywords

hip fractures, broken hip, femoral neck fractures hip fracture, fracture of the hip, femoral head fractures, trochanteric fractures, subtrochanteric fractures, hip joint, iliofemoral ligament, ischiofemoral ligament, avascular necrosis, intracapsular fracture, extracapsular fracture, anterior dislocation, posterior dislocation, single fragment fracture, comminuted fracture, stress fracture, incomplete fracture, impacted fracture, partially displaced fracture, completely displaced fracture, single fracture lines, multiple fracture lines, nondisplaced fracture

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Richard S Goodman, MD, JD, FAAOS, Chair, Department of Surgery, SABA University Medical School; Consulting Staff, Department of Orthopedics, Long Island Jewish/North Shore University Hospital
Richard S Goodman, MD, JD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Bar Association, American College of Legal Medicine, American College of Surgeons, Arthritis Foundation, Eastern Orthopaedic Association, International College of Surgeons, Medical Society of the State of New York, and Pan American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

James F Kellam, MD, Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center
James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James J McCarthy, MD, FAAOS, FAAP, Associate Professor, Consulting Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health;
James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, Orthopaedics Overseas, Pediatric Orthopaedic Society of North America, Pennsylvania Medical Society, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD, Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases
William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine
Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.