Intertrochanteric Bone Fracture Treatment | Surgery

Intertrochanteric break is one of the kinds of hip cracks. The region of the fracture is found on the upper part of the thigh or the proximal femur. This part of the femur has the femoral head, trochanteric region, and the femoral neck. Intertrochanteric is found between the lesser trochanter (hip flexor muscles) and the greater trochanter (hip abductors and extensors). The other hip fractures that are almost related to intertrochanteric fracture are the femoral neck fracture and the subtrochanteric fracture. This is the classification of the hip fractures, based on their region where each fracture happens to be. The distinction of each fracture of hips is necessary because they still need different bodies, prognosis, and fracture management. There are different hip fracture treatments, including that of intertrochanteric fracture treatment, that are already used now. For instance, femoral neck fracture usually uses prosthesis as the stand-in for the broken femur. On the other hand, the hip intertrochanteric fracture is treated with the use of metallic fixation device. This is an internal splintage device that can be effective when used for minimally displaced or nondisplaced intertrochanteric fracture. It can also prove useful for maintaining the fragments of fractures with anatomic and near-anatomic positions. Just like how a fracture brace works, the internal splintage device can be used for intertrochanteric fracture treatment.

Another popular treatment for any injury to the intertrochanteric region is fracture surgery. Although nonsurgical methods are also used to treat intertrochanteric fracture, the relatively new fracture cast in full body coverage or spica cast is more preferred by surgeons these days. The nonsurgical methods on how to heal this intertrochanteric femur fracture are prolonged immobilization, bed rest, and traction in bed, which are boring and severely limiting moments in life. This is why some patients cannot wait for the intertrochanteric fracture healing time to be over. However, these methods still work but some issues arise with their association with mortality and morbidity rates. Some fracture complications also occur with these nonsurgical treatments, such as:

• Bedsores from long term bed rest during intertrochanteric bone fracture recovery
• Pulmonary complications due to immobility and bed rest for such a long time
• Muscle atrophy and motion difficulty for the lower extremity joints due to long time immobilization
• Deep vein thrombosis and pulmonary emboli due to immobilization especially of the extremities
• Union of the broken pieces of the injured bone in unintended positions that result to deformed bones, or what is called as malunion of the fractured intertrochanteric bone

Since surgical procedures are now regarded as the best solution for intertrochanteric fractures, it is now the widely used and preferred solution for many patients with this type of fracture injury. This procedure also has another name which is ORIF or open reduction and internal fixation.

A fixation device needs to be used fractured intertrochanteric part of the hips. However, the surgeon should carefully decide which type of fixation device is appropriate for a certain type of intertrochanteric fracture classification. The manufacturers of such a device also have some instructions that should be followed during the actual use of the fixation helper. It is only after careful diagnosis that the doctor would know the right medicines and procedure to do for a certain classification of the fracture, whether it is complete comminuted intertrochanteric fracture or something else.

History of the Intertrochanteric Treatment

In 1850, Langenbeck tried doing internal fixation surgery on a reduced fracture with the use of an intramedullary nail. There was one time when the trend of using nails became famous, but there were concerns about the source of the necessary intertrochanteric nail. Moreover, the use of the nails during a blind reduction and fixation for broken introchanteric bones only likely resulted to a malpositioned installation of the nail inside the body.

It was in 1851 that intertrochanteric femoral fracture was first described by Cooper. During his studies, he recommended the use of a steady support and a little bit of extension in order to put the limbs and bones back to their original position. Cooper was also the first person to develop a distinction between the outer part of the joint capsule or extracapsular and the neck of the region of the proximal femur or intracapsular. He recommended solutions like bed rest, use of crutches or cane, and wearing an elevated shoe to help hasten the recovery of intertrochanteric fractures.

In 1902, Royal Whitman observed positive progress in intertrochanteric fracture femur when he used aduction, traction with anesthesia, internal rotation, and spica cast for immobilization.

At present, surgical procedures make use of radiographs in order to do the reduction of comminuted intertrochnateric fracture with success. Some guide wires are now used during the insertion of the fixation device to help put all the broken pieces correctly together. Screws are also used to hold the proximal fragment in place while some are used to pin the plate to the distal femur. The last touch would be the use of the compression screw that combines the distal and proximal fragments together.

Statistics

On average, the US sees 252,000 hip fracture cases every year. It is the right or left intertrochanteric fracture that is pointed out as the reason of 3.5 million hospital cases in the country as well, more so than those other fractures such as sacral fracture, tibial fracture, and hangman fracture and other vertebral fractures. There are also other types of fractures that can land a patient in the hospital even for a short time such as growth plate fracture, greenstick fracture, buckle fracture, and more. A hospital stay for a severe case of Galeazzi fracture would also be necessary.

Intertrochanteric Fracture Treatment

If the intertrochanteric crest in the elderly people is fractured or any part in the region, it is a much more complicated case than when the intertrochanteric injury happens to younger people. The case would become even worse when the patient already has a pathologic condition. Moreover, most elderly people can no longer take the stress brought about by trauma, anesthesia, and surgery. It might even be easier to treat intertrochanteric fracture in children. The need for rehabilitation in the cases of the elderly has to be extensive. The pathologic conditions that can make matters even worse for the elderly people include cardiac insufficiency, pulmonary insufficiency, aortic valve insufficiency, mitral valve insufficiency, hypertension, cardiovascular insufficiency, malnutrition, dehydration, and other endocrine and metabolic diseases. Postoperative stress problems might also happen in elderly people. These are the reasons why treatment for left or right intertrochanteric hip fracture must be done carefully for this age group. In fact, there is a two-stage intertrochanteric fracture surgery that is now used today in order to make the operation less risky for them. Without the surgery, they still have to face some more complications and risks. In most cases, a surgical procedure in adults is necessary because unlike children, the bones of the latter no longer grow. Thus, recovery time might be longer than necessary or the fracture might never even heal without surgery.

Indications

The ORIF surgical procedure is highly recommended for the bone fracture treatment of any type of intertrochanteric injuries. However, this might not be good for patients with contraindications for spinal or general anesthesia. Pain can undoubtedly be felt during surgery hence the need to anesthesia. Some other clients who might not benefit from surgery are those that encounter uncontrollable bleeding during operation, have noncorrectable metabolic disorder with high mortality rate, and have a stable fracture but decline to have the surgery for some personal reasons.

Contraindications

These contraindications to surgery are basically those conditions that do not allow the patient to take surgery. With these factors taken into account, other solutions should at least be used in order to help those with conditions that make surgery impossible for them. The doctor would not put a patient in vain.

Prognosis

A stable hip fracture can start healing completely. On how to treat intertrochanteric fracture quick, the doctor should be consulted. But the treatment of the fracture cannot be forced because there are many other factors that also come into play. The best thing for a patient to do to help big on how to heal the fracture would be to follow whatever the doctor says and to go to doctor’s appointments too. In the case of the elderly people, the level of their activity drops a notch down even after they have already healed their fracture. These same patients also have 20 to 30 percent mortality rate a year after the injury happened. This same mortality rate also applies even for patients who do not have many pathologic conditions.