Intertrochanteric femur fractures occur in older patients than femoral neck fractures. It has been estimated that 75% of all hip fractures occur in women and that one-third of all women reaching age 90 years will have sustained a hip fracture. This does not account for patients younger than the age of 65 years, nor does it account accurately for the patients admitted with multiple injuries necessarily and certainly not the young high-energy intertrochanteric femur fracture patient. This number decreased from 1996 to 2010, potentially because of the increased awareness and treatment of osteoporosis, but the incidence is still expected to rise by 12% from 2010 to 2030, therefore resulting in 289,000 annually. In 2010, there were 258,000 hospital admissions for hip fractures in people age 65 years and older according to the National Hospital Discharge Summary in the United States. The incidence of hip fractures worldwide is estimated at 1.6 million. This chapter describes the evaluation and treatment of both high- and low-energy intertrochanteric hip fractures. The intertrochanteric region of the femur is defined as the region from the extracapsular femoral neck to the area just distal to the lesser trochanter. Many of these can be modulated more successfully now than ever before, and careful attention must be paid to each aspect of the care of a patient with this fracture. The surgeon-specific variables include fracture reduction, implant selection, and position of the implant within the bone. Patient-directed factors include prefracture comorbidities, bone quality, other concurrent injuries, and social support. Multiple factors are responsible for the reduction and fixation that a surgeon can achieve. Goals of surgical treatment for any fracture include the maintenance of overall length and alignment and the restoration of bony contact to maximize the ability for mobilization and weight-bearing. How this is achieved is often quite different for these patients, and as middle-age patients continue to evolve as more active patients, the demographic intersection of these two groups becomes more difficult to delineate and demands that the treating orthopaedist be well versed in all facets of care of the patient with an intertrochanteric femur fracture. The goals of successful treatment of these groups of patients are somewhat divergent but include the overall restoration of bony architecture, pain control, and eventual union. These fractures occur in both young patients with high-energy injuries and in patients with osteoporosis. The recognition of the importance of physician and hospital care of elderly patients with intertrochanteric femur fracture is apparent, and the development of geriatric co-management programs has successfully improved patient care while decreasing cost. Treatment of a failed, infected osteosynthesis of a pertrochanteric fracture.įractures of the hip have long been held as an injury, largely as a result of altered bone metabolism, that can significantly affect the life of a patient with regard to mortality and function. The following video is included with this chapter and may be viewed at : Additional videos related to the subject of this chapter are available from the Medizinische Hochschule Hannover collection.
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