Hip

Subtrochanteric Fracture

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Subtrochanteric Fracture, Subtrochanteric Femur Fracture

  • See Also
  1. Hip Fracture
  • Epidemiology
  1. Uncommon Hip Fracture (accounts for only 3% of Hip Fractures)
  • Pathophysiology
  1. Images
    1. hipFractureRegions.jpg
  2. Extracapsular Hip Fracture
    1. Contrast with Femoral Neck Fracture
  3. Mechanism of injury: Direct blunt Trauma
    1. High energy injury
    2. Gun shot wound
    3. Falls in the elderly
    4. Pathologic Fracture (Paget's Disease, Metastases)
  • Diagnosis
  1. See Hip Fracture
  2. First 5 cm of femoral shaft below lesser trochanter
    1. Above Femoral Shaft Fracture
    2. Below Intertrochanteric Fracture
  3. Descriptive Classification
    1. Proximal or distal location
    2. Transverse or oblique angle
    3. Comminuted (common)
  • Management
  1. See Hip Fracture
  2. Evaluate for associated injuries (see pitfalls below)
  3. Strongly consider regional Nerve Block (Fascia Iliaca Block or PENG Block) in hip and Femur Fractures
  4. Closely manage fluid status
    1. Initial Resuscitation with isotonic crystalloid
    2. Type and Cross for 2 Units pRBC
    3. Continually reassess hemodynamic status
  5. Intramedullary rod and nail (stabilizes femoral head and shaft)
    1. Perform in first 48 hours
  • Pitfalls
  1. Significant blood loss
    1. From Hip Fracture or due to associated injuries
  2. Coexisting Fractures are common (up to 50%)
    1. Pelvic Fracture
    2. Vertebral Fracture
  3. High energy Trauma is associated with other injuries
    1. Thoracic Injury
    2. Abdominal Injury
  • Complications
  1. Fat embolism
  2. Immobility associated morbidity
  • Prognosis
  1. Mortality up to 20% due to comorbid injuries
  • References
  1. Gurr in Marx (2002) Rosen's Emergency Med, p. 655-60
  2. Schroeder (2022) Am Fam Physician 106(6): 675-83 [PubMed]
  3. Sims (2002) Orthop Clin North Am 33(1):113-26 [PubMed]