Approach Considerations

The presence of coexisting medical conditions is determined by means of a complete physical examination; cardiac, laboratory, and pulmonary studies; and any other studies that may be indicated. Preoperative tests frequently include a complete blood count (CBC), urinalysis, an SMA-12 (sequential multiple analysis–12-channel biochemical profile), chest radiography, and electrocardiography (ECG).

Additional tests may be required, depending on the clinical findings, the past and current medical history, and the results of screening laboratory studies and imaging. Any medical abnormalities are treated promptly and appropriately before surgical intervention to ensure that complications do not occur because of any unnecessary delay in initiating surgery. Appropriate measures are instituted to decrease the possibility of deep vein thrombosis (DVT) and secondary pulmonary embolism (PE; usually considered a preoperative protocol).

Imaging Studies

Necessary radiographs of the hip include an anteroposterior (AP) view of the pelvis and the involved hip and either a cross-table lateral view or a frog lateral view of the hip. The pelvis radiograph is useful for preoperative planning, particularly to determine the neck shaft angles for placement of cephalomedullary nails.

In some cases, a frog lateral view, computed tomography (CT), or even a reconstituted CT scan of the hip may be necessary to define the fracture in sufficient detail to allow accurate planning of the surgical procedure.

A traction AP radiograph is helpful for further delineating the fracture pattern if significant displacement has occurred.

Treatment & Management

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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.