Subtrochanteric Hip Fracture
What is Subtrochanteric Hip Fracture?
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
Types of Subtrochanteric Hip Fractures
A subtrochanteric hip fracture is a break between the lesser trochanter and the area approximately 5 centimeters below the lesser trochanter. The fracture can be classified based on its location:
- Type I occurs at the level of the lesser trochanter
- Type II occurs within 2.5 cm below the lesser trochanter
- Type III occurs between 2.5 and 5 cm below the lesser trochanter
Causes of Subtrochanteric Hip Fractures
A subtrochanteric hip fracture is most frequently caused by minor trauma in elderly patients with weak bones, and by high-energy trauma in young people. The long-term use of certain medicines, for example, medication for osteoporosis (a disease causing weak bones) and other bone diseases, increases the risk of subtrochanteric hip fractures.
Signs and Symptoms of Subtrochanteric Hip Fractures
The signs and symptoms of subtrochanteric hip fractures include:
- Inability to bear weight on injured extremity
- Pain in the groin or outer upper thigh
- Swelling and tenderness
- Discomfort while rotating the hip
- Shortening of the injured leg
- Outward or inward turning of the foot and knee of the injured leg
Diagnosis of Subtrochanteric Hip Fractures
Your doctor may order an X-ray to diagnose subtrochanteric hip fracture. Other imaging tests, such as magnetic resonance imaging (MRI) may also be performed to detect the fracture.
Surgery for Subtrochanteric Hip Fractures
Surgery is usually the main treatment for subtrochanteric fractures.
- Intramedullary fixation involves managing the fracture with a long intramedullary nail that is fixed with a large screw. Additional screws known as interlocking screws are inserted at the lower end of the nail to prevent rotation of bones around the nail.
Risks and Complications of Surgery for Subtrochanteric Hip Fractures
As with any surgical procedure, surgery for a subtrochanteric fracture may involve certain risks and complications including:
- Nonunion of the fracture with pain
- Limping or limited hip rotation due to malunion
- Nail or screw fixation failure
- Wound infection
- Blood clot (DVT) or pulmonary embolism