Intertrochanteric Hip Fractures Clinical Presentation

Updated: Mar 23, 2023
  • Author: James F Kellam, MD, FRCSC, FACS, FRCS(Ire); Chief Editor: William L Jaffe, MD  more...
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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).



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.