Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Subtrochanteric Hip Fractures Workup

  • Author: Mark A Lee, MD; Chief Editor: William L Jaffe, MD  more...
 
Updated: Jun 22, 2016
 

Imaging Studies

Biplanar plain radiography is the basic and essential imaging study for the diagnosis of subtrochanteric femur fractures. Full-length anteroposterior (AP) views of the femur from the hip to the knee should be obtained. A cross-table lateral view of the hip allows evaluation of the femoral neck and assessment of the extent of the fracture. An AP view of the pelvis is also required, as well as views of the ipsilateral knee, because of the frequency of associated injuries.

Computed tomography (CT) is not usually useful or necessary for surgical planning in these injuries.

When a pathologic fracture is suspected, screening studies such as technetium bone scanning or magnetic resonance imaging (MRI) may be indicated to rule out other sites of skeletal involvement. Screening chest radiography is also necessary to screen for possible pulmonary metastases.

 
 
Contributor Information and Disclosures
Author

Mark A Lee, MD Associate Professor, Director of Orthopedic Trauma Fellowship, Department of Orthopedic Surgery, University of California at Davis School of Medicine

Mark A Lee, MD is a member of the following medical societies: Orthopaedic Trauma Association, AO Foundation

Disclosure: Received grant/research funds from Synthes, USA for none; Received honoraria from Synthes, USA for speaking and teaching; Received consulting fee from Biomet, USA for consulting; Received consulting fee from Zimmer, USA for speaking and teaching; Received grant/research funds from Spinesmith for none.

Coauthor(s)

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

David A Forsh, MD Chief, Orthopedic Trauma Surgery, Assistant Professor, Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai

David A Forsh, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, AO North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

B Sonny Bal, MD, JD, MBA Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD, JD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Received none from Bonesmart.org for online orthopaedic marketing and information portal; Received none from OrthoMind for social networking for orthopaedic surgeons; Received stock options and compensation from Amedica Corporation for manufacturer of orthopaedic implants; Received ownership interest from BalBrenner LLC for employment; Received none from ConforMIS for consulting; Received none from Microport for consulting.

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 Orthopaedic Association, American College of Surgeons, Eastern Orthopaedic Association, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Additional Contributors

Steven I Rabin, MD Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Orthopedic Surgery, Podiatry, Rheumatology, Sports Medicine, and Pain Management, Dreyer Medical Clinic; Chairman, Department of Surgery, Provena Mercy Medical Center

Steven I Rabin, MD is a member of the following medical societies: AO Foundation, American Academy of Orthopaedic Surgeons, American Fracture Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

References
  1. Chapman MW, Campbell WC. Chapman's Orthopaedic Surgery. 3rd ed. Philadelphia, Pa:. Lippincott Williams & Wilkins. 2001.

  2. Rockwood CA, Green DP, Bucholz RW, Heckman JD. Rockwood, Green, and Wilkins' Handbook of Fractures. 5th ed. Philadelphia, Pa:. Lippincott Williams & Wilkins. 2001.

  3. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002 Nov. 84(8):1093-110. [Medline].

  4. Koch JC. The laws of bone architecture. Am J Anat. 1917. 21:177-298. [Full Text].

  5. Bergmann G, Graichen F, Rohlmann A. Hip joint loading during walking and running, measured in two patients. J Biomech. 1993 Aug. 26(8):969-90. [Medline].

  6. Senter B, Kendig R, Savoie FH. Operative stabilization of subtrochanteric fractures of the femur. J Orthop Trauma. 1990. 4(4):399-405. [Medline].

  7. Boyd AD, Wilber JH. Patterns and complications of femur fractures below the hip in patients over 65 years of age. J Orthop Trauma. 1992. 6(2):167-74. [Medline].

  8. Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Steinbuch M, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2009 May 30. [Medline].

  9. Kloen P, Rubel IF, Lyden JP, Helfet DL. Subtrochanteric fracture after cannulated screw fixation of emoral neck fractures: A report of four cases. J Orthop Trauma. 2003. 17:225-233. [Medline].

  10. Ekström W, Németh G, Samnegård E, Dalen N, Tidermark J. Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury. 2009 Apr. 40(4):371-6. [Medline].

  11. Karunakar M, McLaurin TM, Morgan SJ, Egol KA. Improving outcomes after pertrochanteric hip fractures. Instr Course Lect. 2009. 58:91-104. [Medline].

  12. Waddell JP. Subtrochanteric fractures of the femur: a review of 130 patients. J Trauma. 1979 Aug. 19(8):582-92. [Medline].

  13. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop Relat Res. 1989 Jan. (238):122-30. [Medline].

  14. Egol KA. Opinion: Open reduction and internal fixation in conjunction with total hip arthroplasty. J Orthop Trauma. 2005 Jan. 19(1):60-1. [Medline].

  15. [Guideline] American Academy of Orthopaedic Surgeons. Management of hip fractures in the elderly: evidence-based clinical practice guideline. Available at http://www.aaos.org/research/guidelines/HipFxGuideline.pdf. Accessed: September 11, 2014.

  16. Craig NJ, Sivaji C, Maffulli N. Subtrochanteric fractures. A review of treatment options. Bull Hosp Jt Dis. 2001. 60(1):35-46. [Medline].

  17. DeLee JC, Clanton TO, Rockwood CA Jr. Closed treatment of subtrochanteric fractures of the femur in a modified cast-brace. J Bone Joint Surg Am. 1981 Jun. 63(5):773-9. [Medline].

  18. Kraemer WJ, Hearn TC, Powell JN, Mahomed N. Fixation of segmental subtrochanteric fractures. A biomechanical study. Clin Orthop. 1996 Nov. (332):71-9. [Medline].

  19. Craig NJ, Maffulli N. Subtrochanteric fractures: current management options. Disabil Rehabil. 2005 Sep 30-Oct 15. 27 (18-19):1181-90. [Medline].

  20. Craig NJ, Maffulli N. Subtrochanteric fractures: current management options. Disabil Rehabil. 2005 Sep 30-Oct 15. 27(18-19):1181-90. [Medline].

  21. Saarenpää I, Heikkinen T, Jalovaara P. Treatment of subtrochanteric fractures. A comparison of the Gamma nail and the dynamic hip screw: short-term outcome in 58 patients. Int Orthop. 2007 Feb. 31(1):65-70. [Medline].

  22. Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res. 1984. 2(3):297-305. [Medline].

  23. Lundy DW, Acevedo JI, Ganey TM, et al. Mechanical comparison of plates used in the treatment of unstable subtrochanteric femur fractures. J Orthop Trauma. 1999 Nov. 13(8):534-8. [Medline].

  24. Kinast C, Bolhofner BR, Mast JW, Ganz R. Subtrochanteric fractures of the femur. Results of treatment with the 95 degrees condylar blade-plate. Clin Orthop. 1989 Jan. (238):122-30. [Medline].

  25. Sanders S, Egol KA. Adult periarticular locking plates for the treatment of pediatric and adolescent subtrochanteric hip fractures. Bull NYU Hosp Jt Dis. 2009. 67(4):370-3. [Medline].

  26. Sanders R, Regazzoni P. Treatment of subtrochanteric femur fractures using the dynamic condylar screw. J Orthop Trauma. 1989. 3(3):206-13. [Medline].

  27. Vaidya SV, Dholakia DB, Chatterjee A. The use of a dynamic condylar screw and biological reduction techniques for subtrochanteric femur fracture. Injury. 2003 Feb. 34(2):123-8. [Medline].

  28. Hasenboehler EA, Agudelo JF, Morgan SJ, Smith WR, Hak DJ, Stahel PF. Treatment of complex proximal femoral fractures with the proximal femur locking compression plate. Orthopedics. 2007 Aug. 30(8):618-23. [Medline].

  29. Massoud EI. Fixation of subtrochanteric fractures : Does a technical optimization of the dynamic hip screw application improve the results?. Strategies Trauma Limb Reconstr. 2009 Oct. 4(2):65-71. [Medline]. [Full Text].

  30. Brien WW, Wiss DA, Becker V. Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail. J Orthop Trauma. 1991. 5(4):458-64. [Medline].

  31. Wiss DA, Brien WW. Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing. Clin Orthop. 1992 Oct. (283):231-6. [Medline].

  32. Queally JM, Harris E, Handoll HH, Parker MJ. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2014 Sep 12. CD004961. [Medline].

  33. Jiang SD, Jiang LS, Zhao CQ, Dai LY Md Phd. No advantages of Gamma nail over sliding hip screw in the management of peritrochanteric hip fractures: A meta-analysis of randomized controlled trials. Disabil Rehabil. 2007 Jul 13. 1-5. [Medline].

  34. Yoon RS, Donegan DJ, Liporace FA. Reducing subtrochanteric femur fractures: tips and tricks, do's and don'ts. J Orthop Trauma. 2015 Apr. 29 Suppl 4:S28-33. [Medline].

  35. Riehl JT, Widmaier JC. Techniques of Obtaining and Maintaining Reduction During Nailing of Femur Fractures. Orthopedics. August 2009. 32:581-588. [Medline].

  36. Hoskins W, Bingham R, Joseph S, Liew D, Love D, Bucknill A, et al. Subtrochanteric fracture: the effect of cerclage wire on fracture reduction and outcome. Injury. 2015 Oct. 46 (10):1992-5. [Medline].

  37. Larsson S, Friberg S, Hansson LI. Trochanteric fractures. Mobility, complications, and mortality in 607 cases treated with the sliding-screw technique. Clin Orthop. 1990 Nov. (260):232-41. [Medline].

  38. Archdeacon MT, Cannada LK, Herscovici D Jr, Ostrum RF, Anglen JO. Prevention of complications after treatment of proximal femoral fractures. Instr Course Lect. 2009. 58:13-9. [Medline].

 
Previous
Next
 
Injury radiograph of high-energy intertrochanteric fracture with reverse obliquity.
Subtrochanteric fracture repaired with cephalomedullary nail.
The Seinsheimer classification of subtrochanteric femur fractures.
The Arbeitsgemeinschaft für osteosynthesefragen–Association for the Study of Internal Fixation (AO-ASIF) classification of subtrochanteric femur fractures.
The Russell-Taylor classification of subtrochanteric femur fractures.
Reverse obliquity subtrochanteric femur fracture malreduced with a short cephalomedullary nail
Subtrochanteric femur fracture reduction revised and stabilized with a blade plate. Patient went on to heal and return to full function without pain.
Subtrochanteric femur fracture repaired with cephalomedullary device
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.