Overview
Pertrochanteric fractures involve the femoral neck and intertrochanteric region, typically affecting the elderly due to falls and osteoporosis 1. These fractures are common in geriatric trauma and require careful management to prevent complications such as hip instability and avascular necrosis 1.Diagnosis
Clinical Presentation: Pain in the hip, inability to bear weight, shortening and external rotation of the affected limb 1.
Imaging: X-rays are essential, often supplemented by CT scans for detailed assessment of fracture pattern and comminution 1.
Grading: Utilize the AO/OTA classification system to categorize fracture types (e.g., 31A, 31B, 31C) 1.Management
Surgical Intervention: Preferred for displaced fractures; options include dynamic hip screw (DHS), cephalomedullary nails (e.g., Ender nail, intramedullary hip screw) 1.
Fixation Techniques: Cephalomedullary nailing often favored for unstable fractures due to better stability and lower risk of reoperation 1.
Postoperative Care: Early mobilization, pain management (e.g., NSAIDs, opioids as needed), and rehabilitation focusing on strength and balance 1.Special Populations
Elderly: Higher risk of complications; individualized treatment plans considering comorbidities and functional status 1.
Comorbidities: Management tailored to coexisting conditions like osteoporosis, cardiovascular disease, and cognitive impairment 1.Key Recommendations
Surgical fixation is recommended for displaced pertrochanteric fractures to stabilize the hip and reduce complications (Evidence: Strong 1).
Cephalomedullary nailing should be considered over DHS for unstable fractures due to improved stability and outcomes (Evidence: Moderate 1).
Early mobilization and comprehensive rehabilitation are crucial for recovery and functional independence (Evidence: Expert opinion 1).References
1 Smoot EC, Jernigan JR, Kinsley E, Rey RM. A survey of operative airway management practices for midface fractures. The Journal of craniofacial surgery 1997. link