Subtrochanteric hip fractures - proximal femur fractures

#subtrochanteric #femur #thigh
Subtrochanteric hip fracture is a break between the lesser trochanter and the area approximately 5 cm below the lesser trochanter.
immediate, severe pain.
not be able to put weight
injured leg may look deformed, shorter than the other leg and no longer straight.
management.
Conservative treatment involves avoiding stress on the fracture,
typically, through consistent bed rest with skeletal traction through a proximal tibial pin or a distal femoral pin.
we recommend that femoral subtrochanteric fractures in polytrauma patients be repaired within 2 to 12 hours of injury,
performing operative fracture repair within the first 24 hours decreases mortality, respiratory complications, multisystem organ failure, and length of hospitalization.
Currently, the method most surgeons use for treating subtrochanteric fractures is intramedullary nailing.
The rod passes across the fracture to keep it in position.
Intramedullary nailing provides strong, stable fixation.
In certain fractures where comminution is severe to an extent that an intramedullary device can actually create more fracture displacement,
the blade plates and locking plates are more useful.
The plates are also helpful in cases where intramedullary nails are difficult to insert as in narrow intramedullary canal,
both in cases with severe deformities, which could result in malalignment with the nail insertion,
and in cases where better screw purchase and stability are required as in periprosthetic fractures.
Besides these, the plates should always be kept as backup options for a failed intramedullary nailing procedure.
During this operation, the bone fragments are first repositioned into their normal alignment.
They are held together with screws and metal plates attached to the outer surface of the bone.
The most successful type of plating involves the use of 95-degree fixed angle blade plates.
Another form of fixed angle plating includes proximal femoral locking plates.
In cases where there is severe injury to the muscles, nerves or arteries
or there is significant contamination with dirt, rocks or grass from the injury,
some patient requires external fixation prior to definitive surgical treatment.
External fixation may be used in unstable polytrauma,
to ensure the patient is physiologically optimized prior to definitive fixation.
This is an operation, metal pins are placed into the bone above and below the fracture site
through small cuts.
The pins are attached to a bar outside the skin. to stabilize the fracture and hold the bones in the proper position.
After secondary operations to clean the wound or recovery of skin injuries, or if the patient is physiologically optimized,
the external fixator can be removed and plates and intramedullary nails or plates and screws can be placed.
Recovery after surgery:
Postoperative activity depends upon the adequacy of internal fixation.
If fixation is solid, an agile, cooperative patient can be out of bed within a few days of surgery.
and ambulating on crutches with toe touch weight bearing on the affected side.
Follow-up patient visits with the orthopedic surgeon to monitor fracture healing with radiographs are generally performed at approximately two weeks, six weeks, three months, six months, and one year post injury.
Most femoral shaft fractures take 3 to 6 months to completely heal.
Some take even longer,
especially if the fracture was open,
or broken into several pieces,
or if the patient uses tobacco products, or if he is diabetic.
Cutting down or quitting smoking and tight blood sugar control is important for the healing process.
Physical therapy will help to restore normal muscle strength, joint motion, and flexibility.
It can also help you manage your pain after surgery.
Most patients need about 3-4 months of therapy to regain their preinjury range of motion and strength.
Patients usually have good ambulation within 1 month
and can expect to return to normal activity within 3 to 6 months in younger patients,
and up to 12 months in elderly patients.
Athletes may safely return to sports when the femur is completely healed and normal strength and range of motion are regained.
Most athletes return to preinjury levels of function after approximately 9 to 12 months or longer depending upon the complexity of the injury.
The intramedullary nail usually stays in for life and are not routinely removed.
However, if the metal becomes infected or is painful 1 year after surgery it can be removed.