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A case of bilateral simultaneous traumatic intertrochanteric fracture

In orthopedic traumatology, a unilateral intertrochanteric fracture is probably one of the commonest fractures in the elderly. The incidence of bilateral pathological intertrochanteric fracture is also not uncommon. In this case report, we are presenting a case of bilateral simultaneous traumatic displaced intertrochanteric fractures in a young patient. The patient had met with a road traffic accident and sustained injuries to both hips. Surprisingly the patient didn't have any other injuries. His both hips were operated by a staged procedure providing a good functional outcome.
J.Harshvadhan & M.M.Prabhakar: A case of bilateral simultaneous traumatic intertrochanteric fracture in a young patient due to dashboard injury . The Internet Journal of Orthopedic Surgery. 2008 Volume 10 Number 2

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DHS fixation of the hip through keyhole approach

Video report of technique for doing internal fixation of an Intertrochanteric fracture of the hip through a minimal incision (5 cms)

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Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?

Abstract Aims: To examine the roles of fracture stability, anatomical reduction and screw position on cut through failure of Dynamic Hip Screw (DHS) implants. Methods: This is a retrospective study of consecutive patients treated with a DHS implant following intertrochanteric fractures of the proximal femur. Fracture stability was assessed from fracture configuration in the initial presentation films. Adequacy of reduction and screw position within the head and neck were recorded using standardized measurements on AP and lateral radiographs taken intra-operatively and post-operatively. Outcome of surgical fracture fixation was assessed at a minimum of 12 months post-operatively. Results: 135 patients were treated during the study period but 40 had died by 12 months and radiographic records were incomplete in 8 patients.87 patients were included in the final analysis. 32 fractures were incompletely reduced. In 6 cases (6.9%) out of 32,fracture fixation was seen to have failed by way of the screw cutting out of the femoral head.Analysis of screw position in this group showed a 5.4% failure of screws placed centrally and 8.0% failure of screws placed off centre. Conclusions: Incomplete reduction is a strong predictor of implant failure by cut out (p=0.0018). Full Text Citation: Arshad Bhatti, Sohail Quraishi, Simon Tan, D.M. Power: Dynamic Hip Screw Failure: Should We Blame The Surgeon Or The Patient?. The Internet Journal of Orthopedic Surgery. 2004. Volume 2 Number 1.

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Femoral Fractures

Medscape 2000 Report from the Vail Orthopaedics Symposium features
1. Indirect Reduction of the Femur
2. Retrograde and antegrade nailing
3. Supracondylar Femur Fractures
4. Current Treatment of Femoral Neck Fractures
5. Current Technique: Use of Hemiarthroplasty in Femoral Neck Fractures
6. Classification and Treatment of Intertrochanteric Fractures

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Fractures of the Proximal Femur

Radiology Teaching site.
Hip fractures are associated with a substantial mortality, as many as 15-20% dying within one year of the fracture
· Conditions that predispose to hip fractures include aging, osteoporosis and osteomalacia
o Most hip fractures in the elderly (90%) occur as a result of a fall, frequently a minor fall such as from the standing position
· In younger individuals, hip fractures are often the result of high velocity, high impact trauma
· Most hip fractures occur in Caucasian women

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Intertrochanteric fracture Gentili

Radiology of intertrochanteric (IT) fractures. Also sometimes called pertrochanteric

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Intertrochanteric Fractures Sliding Screw Placement in Femoral Head and Neck Wheeless

Anatomical Considerations:
- osseous anatomy of proximal femur dictates where internal fixation device should be placed for maximum purchase in femoral head;
- maximum bone density is found in the area where compression & tension trabeculae coalesce in the center of the head;
- in 1838, int. trabecular system of femoral head was described by Ward;
- maximum bone density is found in area where compression & tension trabeculae coalesce in the center of the head;
- when these trabeculae are absent, surgeon can expect higher rate of failure with use of device;
- most important aspect of device insertion is secure placement of screw within the proximal fragment;
- hence, insert screw centrally to within 1 cm of the subchondral bone;
- this placement ensures adequate purchase in femoral head & solid fixation of femoral head and neck fragment to shaft fragment;
Wheeless' Textbook of Orthopaedics

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Intertrochanteric Fractures Wheeless

Wheeless' Textbook of Orthopaedics Extensive menu on this topic includes -
Classification, Radiography, Work-up, Treatment

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Intertrochanteric Hip Fractures

Intertrochanteric Hip Fractures: OTA Basic Fracture Course

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Intertrochanteric Hip Fractures eMedicine Orthopedics

Author: Richard S Goodman, MD. 2006
An intertrochanteric hip fracture occurs between the greater trochanter, where the gluteus medius and minimus muscles (hip extensors and abductors) attach, and the lesser trochanter, where the iliopsoas muscle (hip flexor) attaches (Netter, 1987).
Updated Nov 2009

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Is the rotation of the femoral head a potential initiation for cutting out Open Access

Since cut-out still remains one of the major clinical challenges in the field of osteoporotic proximal femur fractures, remarkable developments have been made in improving treatment concepts. However, the mechanics of these complications have not been investigated yet. We hypothesize using the experimental data and a theoretical model that a previous rotation of the femoral head due to de-central implant positioning can initiate a cut-out.
Conclusion We conclude the center-center position in the head of femur of any kind of lag screw or blade is to be achieved to minimize rotation of the femoral head and to prevent further mechanical complications.
Is the rotation of the femoral head a potential initiation for cutting out? A theoretical and experimental approach Lenich A, Bachmeier S, Prantl L, Nerlich M, Hammer J, Mayr E, Al-Munajjed A, Fuchtmeier B BMC Musculoskeletal Disorders 2011, 12:79 (full text)

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Outcomes of Gamma Nail Fixation for pertrochanteric fractures

Archived 2003. UPMC. The introduction of the intramedullary hip screw (IMHS) was hailed as a solution for the treatment of complex intertrochanteric (IT) and subtrochanteric (ST) femur fractures. In fixation with the IMHS benefits of intramedullary shaft stabilization are combined with the advantages of sliding hip screw fixation. Fixation with the IMHS is in the canal versus on the lateral cortex with the Dynamic Hip Screw (DHS). This effect decreases the lever arm of the implant and reduces the bending strain on the implant. This biomechanical advantage enables more rigid fixation of complex fractures, and, thus, allows for earlier mobilization. The insertion technique of the IMHS also limits soft tissue disruption, which provides for a theoretical decreased blood loss and fewer problems with wound and fracture healing. One type of intramedullary sliding hip screw, the Gamma Nail (GN) (Howmedica, Rutherford, NJ) was first used in the U.S. in the late 1980ճ. Several studies indicated high rates of complications with use of the GN such as periprosthetic femur fracture (reported to range from 4% to 10%). Other anecdotal complications reported include intraoperative fracture, malunion, and lag screw cut out. The present observational study reports our experience with the GN for all surgeons at the authorճ institution.

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Spot Check Intertrochanteric Fracture Treatment

A recent article in the Journal of Bone and Joint Surgery found a “dramatic change in surgeon preference” from plate fixation to intramedullary (IM) nail fixation for the treatment of intertrochanteric fractures. What method do you use to treat intertrochanteric fractures and why?
Richard F. Kyle, MD

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Total hip arthroplasty following failed fixation of proximal hip fractures

he purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA) following failed fixation of proximal hip fracture.
Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.
Indian J Orthop. 2008 Jul–Sep; 42(3): 279–286.Full text
Total hip arthroplasty following failed fixation of proximal hip fractures Shekhar Srivastav, Vivek Mittal, and Shekhar Agarwal

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Treatment of Intertrochanteric Nonunion of the Proximal Femur Using the S-ROM Prosthesis OrthoSuperSite

Nonunion is an uncommon yet devastating complication following intertrochanteric hip fracture, and few reports in the literature address this problem. This study examines the results of intertrochanteric nonunion treated with the uncemented S-ROM prosthesis in 10 patients. All patients demonstrated clinically significant pain relief and return to ambulation following hemiarthroplasty or total hip arthroplasty. Average Harris hip score was 86 after an average follow-up of 30 months; there was a trend toward better results in cases of pure intertrochanteric fractures compared to cases with subtrochanteric involvement. Radiographic follow-up demonstrated stable ingrowth in 9 cases, and few complications occurred in this series.
ORTHOPEDICS February 2008;31(2):125. Full text Treatment of Intertrochanteric Nonunion of the Proximal Femur Using the S-ROM Prosthesis by Carl T. Talmo, MD; James V. Bono, MD

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