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.

Treatment & Management

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Media Gallery

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

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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)

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.

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.

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, PhD, MBA CEO and President, SINTX Technologies, Salt Lake City, UT

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SINTX Technologies.

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.

Additional Contributors

Steven I Rabin, MD, FAAOS Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Musculoskeletal Services, Dreyer Medical Clinic

Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Subtrochanteric Hip Fractures Workup

Imaging Studies

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