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. Evaluate for associated injuries (see pitfalls below)
  2. Closely manage fluid status
    1. Initial Resuscitation with isotonic crystalloid
    2. Type and Cross for 2 Units pRBC
    3. Continually reassess hemodynamic status
  3. 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]