Overview
Pertrochanteric fractures involve the femoral neck and intertrochanteric region, commonly seen in elderly patients due to falls and osteoporosis 1. These fractures often require surgical intervention to ensure stable fixation and optimal functional outcomes.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 for initial diagnosis, typically showing a fracture line across the femoral neck or intertrochanteric region 1.
Grading: Utilize the AO/OTA classification system for pertrochanteric fractures (AO 31A, 31B, 31C) to guide treatment decisions 1.Management
First-Line Treatment: Surgical fixation with a sliding hip screw and plate or a cephalomedullary nail, depending on fracture morphology and patient factors 1.
Adjunctive Treatments: Postoperative management includes early mobilization, pain control with NSAIDs or opioids as needed, and rehabilitation focusing on strength and balance exercises 1.Special Populations
Elderly: Increased emphasis on minimally invasive techniques and rapid mobilization to prevent complications like deep vein thrombosis and pneumonia 1.
Comorbidities: Tailored surgical approaches considering cardiovascular status, cognitive function, and other comorbidities to optimize outcomes 1.Key Recommendations
Surgical fixation is recommended for displaced pertrochanteric fractures to ensure stable healing and functional recovery (Evidence: Strong 1).
Early mobilization should be initiated postoperatively to prevent complications in elderly patients (Evidence: Moderate 1).
Consider patient-specific factors such as comorbidities and functional status when selecting surgical technique (Evidence: Expert opinion 1).References
1 Scerpella TA, Watson EM. The Forum, Society for Women Sports Medicine Orthopaedic Surgeons. The Journal of the American Academy of Orthopaedic Surgeons 2022. link