History and Physical Examination

Elderly patients frequently have other significant coexisting or preexisting pathologic conditions that reduce their ability to resist the stresses of anesthesia, trauma, and surgery and increase their need for extensive postoperative rehabilitation. Coexisting or preexisting conditions that were present but unknown, undiagnosed, or simply tolerable before the fracture may include the following:

Pulmonary insufficiency
Cardiac insufficiency
Mitral valve insufficiency
Aortic valve insufficiency
Cardiovascular insufficiency
Hypertension
Dehydration
Malnutrition
Any of a number of metabolic diseases or endocrine diseases, including diabetes and hypothyroidism; in addition, metabolic changes are consistent with the postoperative stresses from the postoperative analgesics and the postoperative rehabilitation program

A younger patient with a high-energy fracture has usually been in a significant accident and has the potential for multiple other injuries not only to the musculoskeletal system but also to the remainder of the body, especially the head, chest and abdomen.

In view of the potential for these comorbidities or other injuries, a four-stage treatment program is recommended (see Treatment).

Complications

Medical complications of intertrochanteric hip fractures are secondary to any preexisting medical conditions that have or have not been recognized, diagnosed, or properly treated, depending on the limitations of time and facilities and the current level of medical care. Medical complications include cardiac, pulmonary, renal, hepatic, and vascular conditions.

Workup

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Media Gallery

Normal femur anatomy.
Femur with plate and screws.
Femur with intramedullary rod and screw.
Stable intertrochanteric fracture.
Unstable intertrochanteric fracture.
Intertrochanteric fracture with Enders nail.

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Author

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

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.

James J McCarthy, MD, FAAOS, FAAP Director, Division of Orthopedic Surgery, Cincinnati Children's Hospital; Professor, Department of Orthopedic Surgery, University of Cincinnati College of Medicine

James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Orthopaedic Association, Pennsylvania Medical Society, Philadelphia County Medical Society, Pennsylvania Orthopaedic Society, Pediatric Orthopaedic Society of North America, Orthopaedics Overseas, Limb Lengthening and Reconstruction Society, Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopediatrics, Phillips Healthcare, POSNA<br/>Serve(d) as a speaker or a member of a speakers bureau for: Synthes<br/>Received research grant from: University of Cincinnati<br/>Received royalty from Lippincott Williams and WIcins for editing textbook; Received none from POSNA for board membership; Received none from LLRS for board membership; Received consulting fee from Synthes for none.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University Grossman 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, New York Academy of Medicine

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

Acknowledgements

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.