Pertrochanteric femoral fracture
The fracture usually occurs in older people when they fall onto the corresponding hip. In the case of high-energy trauma (e.g. traffic accidents or falls from a great height), the fracture also occurs in younger people. Pertrochanteric fractures make up about 45 percent of proximal femoral fractures and are therefore just as common as femoral neck fractures . The average age is 70–80 years. Women are affected much more often because they have an increased postmenopausal incidence of osteoporosis .
Usually there is spontaneous pain with aggravation of the symptoms through movement in the area of the affected hip region. The affected leg is shortened and / or rotated outward if there is a displacement of the fracture (= dislocation). The external rotation and shortening is usually not as pronounced as in the presence of a dislocated, medial femoral neck fracture. The mobility is usually significantly restricted or completely eliminated due to pain. There is tenderness to pressure and tapping over the greater trochanter. In the area of the proximal (= body-hugging) thigh, bleeding into the muscles can cause pronounced swelling.
X-rays of the hip joint in two planes confirm the diagnosis. In controversial cases, computed tomography (CT) can be performed.
In the past, femoral fractures were treated with a stretching device (a so-called extension). The associated complications from being confined to bed for a long time, such as pneumonia , thrombosis and pressure ulcers, led to a high mortality rate.
Today the treatment is carried out surgically by means of an osteosynthesis . Only avulsion fractures of the trochanter can be treated conservatively. Frequently used implants are the gamma nail, the proximal femoral nail, sliding nail or similar as well as the dynamic hip screw (DHS) or a percutaneous compression plate (PCCP). The dynamic hip screw is only the method of choice if the lesser trochanter as a medial support is not fractured or can be reconstructed. If the medial support cannot be reconstructed, a medullary splint z. B. using a gamma nail or proximal femoral nail. A pertrochanteric fracture with existing osteoarthritis of the hip joint should be treated with a total endoprosthesis. Whether a dual head prosthesis should be used in patients over 70 years of age or whether the operation should be "bone-sparing" is currently the subject of controversial discussions in the specialist literature.
The loss of blood in the area of the bone fracture can lead to a lack of blood , so that blood transfers may become necessary. Further possible complications are wound healing disorders, thromboses, pneumonia, and the osteosynthesis material breaking out. The elderly have a peri- and postoperative mortality rate that is up to six times higher than that of the comparison group of the same age. Current sources report a mortality rate of around 10% in the first 30 days after the occurrence of a fracture near the hip joint. In the first year after such an injury, the mortality is still 25%.
- Guidelines of the German Society for Trauma Surgery
- Intertrochanteric Fractures Wheeless' Textbook of Orthopedics
- B. Weigel, M. Nerlich: Praxisbuch Unfallchirurgie. Volume 1, Springer, 2005, ISBN 3-540-41115-1 .
- A. Ficklscherer: Basics of Orthopedics and Traumatology . 3. Edition. Elsevier, Urban & Fischer, 2012, ISBN 978-3-437-42208-9 , pp. 68 .
- BL White et al .: Rate of mortality for elderly patients after fracture of the hip in the 1980's. In: J Bone Joint Surg Am. 1987; 69, pp. 1335-1340.